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General NPI Number Information
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NPI Number | 1316273857
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Entity Type | Individual
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Provider Name | JENNIE BIRK MAYNARD P.T.
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Gender | Female
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Dates
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Enumeration Date | 10/18/2009
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Last Update Date | 06/28/2018
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Provider Practice Location Address
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Address Line | 213 QUIET CREEK CT
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City | CHELSEA
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State | MI
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Zip | 48118
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Country | US
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Telephone | 734-355-3035
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Fax | 734-548-8289
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Provider Business Mailing Address
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Address Line | 213 QUIET CREEK CT
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City | CHELSEA
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State | MI
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Zip | 48118-9455
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Country | US
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Telephone | 734-355-3035
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Fax | 734-548-8289
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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 | 225100000X
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Taxonomy Name | Physical Therapist
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License Number | 5501001826
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License Number State | MI
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