Provider Demographics
NPI:1457783516
Name:MCKELVIE, JOANNE M (PTA)
Entity type:Individual
Prefix:
First Name:JOANNE
Middle Name:M
Last Name:MCKELVIE
Suffix:
Gender:F
Credentials:PTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:780 S MILFORD RD
Mailing Address - Street 2:
Mailing Address - City:MILFORD
Mailing Address - State:MI
Mailing Address - Zip Code:48381-2799
Mailing Address - Country:US
Mailing Address - Phone:810-338-3833
Mailing Address - Fax:
Practice Address - Street 1:35746 HARPER AVE
Practice Address - Street 2:
Practice Address - City:CLINTON TWP
Practice Address - State:MI
Practice Address - Zip Code:48035-3212
Practice Address - Country:US
Practice Address - Phone:586-791-9203
Practice Address - Fax:586-791-3633
Is Sole Proprietor?:Yes
Enumeration Date:2013-07-31
Last Update Date:2013-07-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5502002688225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant