Healthcare Provider Details

I. General information

NPI: 1194964734
Provider Name (Legal Business Name): TERRI JEURINK MPT
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/04/2009
Last Update Date: 02/04/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

25 CONRAN DR
COOPERSVILLE MI
49404-1366
US

IV. Provider business mailing address

25 CONRAN DR
COOPERSVILLE MI
49404-1366
US

V. Phone/Fax

Practice location:
  • Phone: 616-997-6172
  • Fax: 616-997-6178
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2251X0800X
TaxonomyOrthopedic Physical Therapist
License Number5501012050
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: