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General NPI Number Information
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NPI Number | 1093921710
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Entity Type | Individual
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Provider Name | JENNIFER SACKRIDER
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Gender | Female
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Dates
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Enumeration Date | 05/16/2007
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Last Update Date | 07/08/2007
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Provider Practice Location Address
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Address Line | 892 E CHICAGO ST STE H
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City | COLDWATER
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State | MI
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Zip | 49036-2063
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Country | US
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Telephone | 517-278-9533
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Fax |
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Provider Business Mailing Address
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Address Line | 128 LOWELL AVE
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City | BATTLE CREEK
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State | MI
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Zip | 49014-8951
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Country | US
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Telephone |
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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 |
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License Number State |
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