Provider Demographics
NPI:1598999278
Name:DYS, JENNIFER LYNN (DPT)
Entity Type:Individual
Prefix:MRS
First Name:JENNIFER
Middle Name:LYNN
Last Name:DYS
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 1:388 GARDEN AVE
Mailing Address - Street 2:SUITE 130
Mailing Address - City:HOLLAND
Mailing Address - State:MI
Mailing Address - Zip Code:49424-8998
Mailing Address - Country:US
Mailing Address - Phone:616-738-7100
Mailing Address - Fax:616-738-7112
Practice Address - Street 1:388 GARDEN AVE
Practice Address - Street 2:SUITE 130
Practice Address - City:HOLLAND
Practice Address - State:MI
Practice Address - Zip Code:49424-8998
Practice Address - Country:US
Practice Address - Phone:616-738-7100
Practice Address - Fax:616-738-7112
Is Sole Proprietor?:No
Enumeration Date:2009-05-08
Last Update Date:2009-05-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5501013508225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist