Provider Demographics
NPI:1639525991
Name:STREB, JANE PALIN (PT)
Entity Type:Individual
Prefix:
First Name:JANE
Middle Name:PALIN
Last Name:STREB
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 1:1773 STAR BATT DR
Mailing Address - Street 2:
Mailing Address - City:ROCHESTER HILLS
Mailing Address - State:MI
Mailing Address - Zip Code:48309-3708
Mailing Address - Country:US
Mailing Address - Phone:248-601-9207
Mailing Address - Fax:586-693-7365
Practice Address - Street 1:2840 KEEWAHDIN RD
Practice Address - Street 2:STE 203
Practice Address - City:FORT GRATIOT
Practice Address - State:MI
Practice Address - Zip Code:48059-3576
Practice Address - Country:US
Practice Address - Phone:586-791-9203
Practice Address - Fax:586-693-7365
Is Sole Proprietor?:No
Enumeration Date:2016-05-05
Last Update Date:2016-05-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5501001979225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist