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NPI Code Detail

MEDICARE: TAMARA K JARDINE PT

MEDICARE: TAMARA K JARDINE 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
1225100000XPhysical Therapist5501002579MI

General Provider Information

NPI Number : 1689844144
Entity Type Code : Individual
Provider Name (Legal Business Name) : TAMARA K JARDINE PT
Provider Business Mailing Address
First Line : 1030 MINERS RD STE C
Second Line :
City : SAINT JOSEPH
State : MI
Zip : 49085-9709
Country : US
Telephone Number :
Fax Number : 269-359-3735
Provider Business Practice Location Address
First Line : 1030 MINERS RD STE C
Second Line :
City : SAINT JOSEPH
State : MI
Zip : 49085-9709
Country : US
Telephone Number : 269-235-9083
Fax Number : 269-359-3735
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 03/11/2008
Last Update Date : 06/26/2024

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