Provider Demographics
NPI:1568619989
Name:BAILEY, JENNIFER LYNN (DPT)
Entity Type:Individual
Prefix:
First Name:JENNIFER
Middle Name:LYNN
Last Name:BAILEY
Suffix:
Gender:F
Credentials:DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1235 S CENTER RD
Mailing Address - Street 2:UNIT 12
Mailing Address - City:BURTON
Mailing Address - State:MI
Mailing Address - Zip Code:48509-1700
Mailing Address - Country:US
Mailing Address - Phone:810-743-8820
Mailing Address - Fax:810-743-5908
Practice Address - Street 1:1235 S CENTER RD
Practice Address - Street 2:UNIT 12
Practice Address - City:BURTON
Practice Address - State:MI
Practice Address - Zip Code:48509-1700
Practice Address - Country:US
Practice Address - Phone:810-743-8820
Practice Address - Fax:810-743-5908
Is Sole Proprietor?:No
Enumeration Date:2008-08-27
Last Update Date:2008-08-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5501013991225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist