Provider Demographics
NPI:1922130962
Name:JACOKES, ALISON MARIE (PTA, ATC)
Entity Type:Individual
Prefix:MRS
First Name:ALISON
Middle Name:MARIE
Last Name:JACOKES
Suffix:
Gender:F
Credentials:PTA, ATC
Other - Prefix:
Other - First Name:ALISON
Other - Middle Name:
Other - Last Name:URAM
Other - Suffix:
Other - Last Name Type:Former 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:586-299-1099
Practice Address - Street 1:5678 SASHABAW RD
Practice Address - Street 2:
Practice Address - City:CLARKSTON
Practice Address - State:MI
Practice Address - Zip Code:48346-3148
Practice Address - Country:US
Practice Address - Phone:248-922-9280
Practice Address - Fax:248-922-9287
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-12
Last Update Date:2024-01-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5502001090225200000X
MI2255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant
No2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer