Healthcare Provider Details

I. General information

NPI: 1710115258
Provider Name (Legal Business Name): JAREN MARIE PICKENS GEBHARD PT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: JAREN MARIE PICKENS M.S.P.T.

II. Dates (important events)

Enumeration Date: 06/23/2009
Last Update Date: 10/19/2022
Certification Date: 10/19/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

13105 SCHAVEY RD
DEWITT MI
48820-9037
US

IV. Provider business mailing address

7402 WESTSHIRE DR STE 105
LANSING MI
48917-8687
US

V. Phone/Fax

Practice location:
  • Phone: 517-853-6800
  • Fax: 517-853-6801
Mailing address:
  • Phone: 517-853-6800
  • Fax: 517-853-6801

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number5501011698
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: