Healthcare Provider Details

I. General information

NPI: 1922112283
Provider Name (Legal Business Name): MOLLY JOHANNA JARIN MSPT
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/17/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

180 LITTLE LAKE DRIVE SUITE 4
ANN ARBOR MI
48103
US

IV. Provider business mailing address

2516 HAMPSHIRE ROAD
ANN ARBOR MI
48104
US

V. Phone/Fax

Practice location:
  • Phone: 734-222-7010
  • Fax: 734-222-7010
Mailing address:
  • Phone: 734-369-4860
  • Fax: 734-369-4860

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number5501012824
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: