Provider Demographics
NPI:1649563990
Name:MCCORMICK, JANET TAYLOR (PT)
Entity Type:Individual
Prefix:MRS
First Name:JANET
Middle Name:TAYLOR
Last Name:MCCORMICK
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 1:1930 W GUNN RD
Mailing Address - Street 2:
Mailing Address - City:ROCHESTER
Mailing Address - State:MI
Mailing Address - Zip Code:48306-1565
Mailing Address - Country:US
Mailing Address - Phone:248-651-8691
Mailing Address - Fax:
Practice Address - Street 1:1930 W GUNN RD
Practice Address - Street 2:
Practice Address - City:ROCHESTER
Practice Address - State:MI
Practice Address - Zip Code:48306-1565
Practice Address - Country:US
Practice Address - Phone:248-651-8691
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-05-19
Last Update Date:2011-05-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL175F00000X
MI5501004273225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
No175F00000XOther Service ProvidersNaturopath