Provider Demographics
NPI:1922429448
Name:SEITZ, JODY
Entity Type:Individual
Prefix:
First Name:JODY
Middle Name:
Last Name:SEITZ
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:34330 VAN BORN RD
Mailing Address - Street 2:
Mailing Address - City:WAYNE
Mailing Address - State:MI
Mailing Address - Zip Code:48184-2472
Mailing Address - Country:US
Mailing Address - Phone:734-721-0740
Mailing Address - Fax:734-722-3646
Practice Address - Street 1:34330 VAN BORN RD
Practice Address - Street 2:
Practice Address - City:WAYNE
Practice Address - State:MI
Practice Address - Zip Code:48184-2472
Practice Address - Country:US
Practice Address - Phone:734-721-0740
Practice Address - Fax:734-722-3646
Is Sole Proprietor?:Yes
Enumeration Date:2013-12-31
Last Update Date:2013-12-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI2553981225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant