Healthcare Provider Details

I. General information

NPI: 1376658849
Provider Name (Legal Business Name): JONATHAN NARR P.T.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/21/2006
Last Update Date: 03/14/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

24715 LITTLE MACK AVE SUITE 100
SAINT CLAIR SHORES MI
48080-3207
US

IV. Provider business mailing address

13107 BURNINGWOOD DR
WASHINGTON MI
48094-1738
US

V. Phone/Fax

Practice location:
  • Phone: 586-779-7970
  • Fax: 586-779-7748
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number5501008098
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: