Provider Demographics
NPI:1821426214
Name:VEDUA, JANE (PT)
Entity Type:Individual
Prefix:
First Name:JANE
Middle Name:
Last Name:VEDUA
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:JANE
Other - Middle Name:MANARANG
Other - Last Name:ABAYARI
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PT
Mailing Address - Street 1:13251 E 10 MILE RD STE 400
Mailing Address - Street 2:
Mailing Address - City:WARREN
Mailing Address - State:MI
Mailing Address - Zip Code:48089-2000
Mailing Address - Country:US
Mailing Address - Phone:586-759-7474
Mailing Address - Fax:586-759-7476
Practice Address - Street 1:13251 E 10 MILE RD STE 400
Practice Address - Street 2:
Practice Address - City:WARREN
Practice Address - State:MI
Practice Address - Zip Code:48089-2000
Practice Address - Country:US
Practice Address - Phone:586-759-7474
Practice Address - Fax:586-759-7476
Is Sole Proprietor?:No
Enumeration Date:2013-10-22
Last Update Date:2021-04-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5501004330225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist