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 1:790 REMINGTON BLVD
Mailing Address - Street 2:
Mailing Address - City:BOLINGBROOK
Mailing Address - State:IL
Mailing Address - Zip Code:60440-4909
Mailing Address - Country:US
Mailing Address - Phone:630-296-2223
Mailing Address - Fax:630-759-3251
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:2014-02-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAPT-018916225100000X
KY005541225100000X
IN05010130A225100000X
PAPT018916225100000X
MI5501016235225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MIN69750073Medicare UPIN