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General NPI Number Information
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NPI Number | 1245514561
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Entity Type | Individual
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Provider Name | NATHANIEL JEANE
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Gender | Male
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Dates
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Enumeration Date | 10/05/2011
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Last Update Date | 10/05/2011
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Provider Practice Location Address
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Address Line | 27240 HAGGERTY RD SUITE E-15
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City | FARMINGTON HILLS
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State | MI
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Zip | 48331-5716
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Country | US
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Telephone | 866-991-0900
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Fax |
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Provider Business Mailing Address
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Address Line | 30 LACROIX RD E
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City | PINEVILLE
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State | LA
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Zip | 71360-7349
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Country | US
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Telephone | 318-512-1990
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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 | 2074711
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License Number State | TX
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