Healthcare Provider Details

I. General information

NPI: 1053554279
Provider Name (Legal Business Name): JENNIFER JUDITH SKURDA PTA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/17/2009
Last Update Date: 04/17/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

729 W ANN ARBOR TRL SUITE 200
PLYMOUTH MI
48170-6225
US

IV. Provider business mailing address

729 W ANN ARBOR TRL SUITE 200
PLYMOUTH MI
48170-6225
US

V. Phone/Fax

Practice location:
  • Phone: 734-414-7056
  • Fax: 734-414-9925
Mailing address:
  • Phone: 734-414-7056
  • Fax: 734-414-9925

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225200000X
TaxonomyPhysical Therapy Assistant
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: