Healthcare Provider Details

I. General information

NPI: 1104199512
Provider Name (Legal Business Name): JENNIFER MARIE SADDLER PTA
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/15/2012
Last Update Date: 02/15/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

13850 E 12 MILE RD STE 2A
WARREN MI
48088-3730
US

IV. Provider business mailing address

13850 E 12 MILE RD STE 2A
WARREN MI
48088-3730
US

V. Phone/Fax

Practice location:
  • Phone: 586-445-3945
  • Fax: 586-553-8310
Mailing address:
  • Phone: 586-445-3945
  • Fax: 586-553-8310

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225200000X
TaxonomyPhysical Therapy Assistant
License Number5502003173
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: