MEDICARE: JAMIE HEBNER PT

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	225100000X	Physical Therapist	5501011245	MI

General Provider Information

NPI Number	:	1184995177
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JAMIE HEBNER PT

Provider Business Mailing Address
First Line	:	607 DEWEY AVE NW STE 300
Second Line	:
City	:	GRAND RAPIDS
State	:	MI
Zip	:	49504-7335
Country	:	US
Telephone Number	:	616-356-5000
Fax Number	:	616-356-5001

Provider Business Practice Location Address
First Line	:	1915 GEORGETOWN CENTER DR STE 102
Second Line	:
City	:	JENISON
State	:	MI
Zip	:	49428-7121
Country	:	US
Telephone Number	:	616-356-5000
Fax Number	:	616-356-5001

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	01/23/2012
Last Update Date	:	05/06/2021

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