Provider Demographics
NPI:1891396719
Name:FENTZ, EMMA (DPT)
Entity Type:Individual
Prefix:
First Name:EMMA
Middle Name:
Last Name:FENTZ
Suffix:
Gender:F
Credentials:DPT
Other - Prefix:
Other - First Name:EMMA
Other - Middle Name:
Other - Last Name:RIFFE
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:33900 HARPER AVE STE 104
Mailing Address - Street 2:
Mailing Address - City:CLINTON TWP
Mailing Address - State:MI
Mailing Address - Zip Code:48035-4258
Mailing Address - Country:US
Mailing Address - Phone:586-350-2644
Mailing Address - Fax:
Practice Address - Street 1:157 HOLIDAY PL
Practice Address - Street 2:
Practice Address - City:FRANKLIN
Practice Address - State:IN
Practice Address - Zip Code:46131-2622
Practice Address - Country:US
Practice Address - Phone:463-222-2010
Practice Address - Fax:463-222-2011
Is Sole Proprietor?:No
Enumeration Date:2020-11-06
Last Update Date:2024-01-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN05014000A225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist