Healthcare Provider Details

I. General information

NPI: 1063581643
Provider Name (Legal Business Name): JENNIFER LYNN BAUMANN P.T., A.T.C.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: JENNIFER LYNN KRIPS P.T., A.T.C.

II. Dates (important events)

Enumeration Date: 11/07/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

133 W MAIN ST #120
NORTHVILLE MI
48167-1520
US

IV. Provider business mailing address

133 W MAIN ST #120
NORTHVILLE MI
48167-1520
US

V. Phone/Fax

Practice location:
  • Phone: 248-347-1168
  • Fax: 248-347-1252
Mailing address:
  • Phone: 248-347-1168
  • Fax: 248-347-1252

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number5501010445
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: