Provider Demographics
NPI:1598081135
Name:HUTTENSTINE, JESSICA NICOLE (DPT)
Entity Type:Individual
Prefix:DR
First Name:JESSICA
Middle Name:NICOLE
Last Name:HUTTENSTINE
Suffix:
Gender:F
Credentials:DPT
Other - Prefix:DR
Other - First Name:JESSICA
Other - Middle Name:NICOLE
Other - Last Name:PRESCOTT
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DPT
Mailing Address - Street 1:33900 HARPER AVE
Mailing Address - Street 2:SUITE 104
Mailing Address - City:CLINTON TOWNSHIP
Mailing Address - State:MI
Mailing Address - Zip Code:48035-4258
Mailing Address - Country:US
Mailing Address - Phone:586-416-9100
Mailing Address - Fax:586-416-9103
Practice Address - Street 1:23310 FORD RD
Practice Address - Street 2:
Practice Address - City:DEARBORN HEIGHTS
Practice Address - State:MI
Practice Address - Zip Code:48127-2376
Practice Address - Country:US
Practice Address - Phone:313-633-9586
Practice Address - Fax:313-633-9589
Is Sole Proprietor?:No
Enumeration Date:2010-04-07
Last Update Date:2014-01-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5501015134225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist