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General NPI Number Information
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NPI Number | 1073826038
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Entity Type | Individual
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Provider Name | JEREMY JOSEPH FLOWERS LPTA
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Gender | Male
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Dates
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Enumeration Date | 07/20/2010
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Last Update Date | 07/20/2010
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Provider Practice Location Address
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Address Line | 1235 S CENTER RD UNIT 12
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City | BURTON
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State | MI
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Zip | 48509-1700
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Country | US
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Telephone | 810-743-8820
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Fax | 810-743-5908
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Provider Business Mailing Address
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Address Line | 2930 MEISNER AVE
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City | FLINT
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State | MI
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Zip | 48506-2434
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Country | US
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Telephone | 810-240-2551
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 225200000X
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Taxonomy Name | Physical Therapy Assistant
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License Number | 5502002581
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License Number State | MI
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