Provider Demographics
NPI:1821541566
Name:WHALLS, JENNIFER ANNE (PT, DPT)
Entity Type:Individual
Prefix:DR
First Name:JENNIFER
Middle Name:ANNE
Last Name:WHALLS
Suffix:
Gender:F
Credentials:PT, DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1235 S CENTER RD
Mailing Address - Street 2:UNIT 12
Mailing Address - City:BURTON
Mailing Address - State:MI
Mailing Address - Zip Code:48509-1700
Mailing Address - Country:US
Mailing Address - Phone:810-743-8820
Mailing Address - Fax:810-743-5908
Practice Address - Street 1:1235 S CENTER RD
Practice Address - Street 2:UNIT 12
Practice Address - City:BURTON
Practice Address - State:MI
Practice Address - Zip Code:48509-1700
Practice Address - Country:US
Practice Address - Phone:810-743-8820
Practice Address - Fax:810-743-5908
Is Sole Proprietor?:No
Enumeration Date:2016-07-29
Last Update Date:2016-07-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5501017774225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist