Provider Demographics
NPI:1578076253
Name:ROSKELLY, JENSYN (PT, DPT, ATC)
Entity Type:Individual
Prefix:
First Name:JENSYN
Middle Name:
Last Name:ROSKELLY
Suffix:
Gender:F
Credentials:PT, DPT, ATC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7532 ORE KNOB DR
Mailing Address - Street 2:
Mailing Address - City:FENTON
Mailing Address - State:MI
Mailing Address - Zip Code:48430-9237
Mailing Address - Country:US
Mailing Address - Phone:810-845-8769
Mailing Address - Fax:
Practice Address - Street 1:223 KALAMAZOO ST
Practice Address - Street 2:
Practice Address - City:EAST LANSING
Practice Address - State:MI
Practice Address - Zip Code:48824-5400
Practice Address - Country:US
Practice Address - Phone:517-355-1627
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-11-16
Last Update Date:2024-03-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI26010020602255A2300X
MI5501020023225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
No2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer