Provider Demographics
NPI:1669637054
Name:CIOLINO, JEANNETTE LOUISE (PT)
Entity Type:Individual
Prefix:MRS
First Name:JEANNETTE
Middle Name:LOUISE
Last Name:CIOLINO
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:JEANNETTE
Other - Middle Name:LOUISE
Other - Last Name:MENTZER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PT
Mailing Address - Street 1:23852 MICHIGAN AVE
Mailing Address - Street 2:
Mailing Address - City:DEARBORN
Mailing Address - State:MI
Mailing Address - Zip Code:48124-1829
Mailing Address - Country:US
Mailing Address - Phone:313-565-4222
Mailing Address - Fax:313-565-8703
Practice Address - Street 1:23852 MICHIGAN AVE
Practice Address - Street 2:
Practice Address - City:DEARBORN
Practice Address - State:MI
Practice Address - Zip Code:48124-1829
Practice Address - Country:US
Practice Address - Phone:313-565-4222
Practice Address - Fax:313-565-8703
Is Sole Proprietor?:No
Enumeration Date:2008-07-24
Last Update Date:2008-07-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5501003688225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist