Provider Demographics
NPI:1629571328
Name:STARCHENKO, JENNIFER SUZANNE (PT)
Entity Type:Individual
Prefix:DR
First Name:JENNIFER
Middle Name:SUZANNE
Last Name:STARCHENKO
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:18731 PARKE EAST CT
Mailing Address - Street 2:
Mailing Address - City:BROWNSTOWN
Mailing Address - State:MI
Mailing Address - Zip Code:48193-4600
Mailing Address - Country:US
Mailing Address - Phone:734-674-8586
Mailing Address - Fax:
Practice Address - Street 1:7445 ALLEN RD STE 102
Practice Address - Street 2:
Practice Address - City:ALLEN PARK
Practice Address - State:MI
Practice Address - Zip Code:48101-1992
Practice Address - Country:US
Practice Address - Phone:313-389-5600
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-03-09
Last Update Date:2021-03-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5501010808225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist