Provider Demographics
NPI:1659564144
Name:KERN, JAIMIE MARIE (MPT)
Entity type:Individual
Prefix:
First Name:JAIMIE
Middle Name:MARIE
Last Name:KERN
Suffix:
Gender:F
Credentials:MPT
Other - Prefix:
Other - First Name:JAIMIE
Other - Middle Name:MARIE
Other - Last Name:DAYOUB
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:2001 BUTTERFIELD RD STE 1600
Mailing Address - Street 2:
Mailing Address - City:DOWNERS GROVE
Mailing Address - State:IL
Mailing Address - Zip Code:60515-1211
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:5222 N ROYAL DR
Practice Address - Street 2:
Practice Address - City:TRAVERSE CITY
Practice Address - State:MI
Practice Address - Zip Code:49684-6883
Practice Address - Country:US
Practice Address - Phone:231-929-0303
Practice Address - Fax:231-929-0305
Is Sole Proprietor?:No
Enumeration Date:2007-08-20
Last Update Date:2025-09-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY005541225100000X
PAPT-018916225100000X
MI5501016235225100000X
IN05010130A225100000X
PAPT018916225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MIN69750073Medicare UPIN