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General NPI Number Information
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NPI Number | 1376256065
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Entity Type | Individual
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Provider Name | JEREMY CROSS PT, DPT
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Gender | Male
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Dates
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Enumeration Date | 12/28/2022
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Last Update Date | 09/19/2024
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Provider Practice Location Address
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Address Line | 45816 SCHOENHERR RD
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City | UTICA
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State | MI
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Zip | 48315-6028
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Country | US
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Telephone | 586-900-2100
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Fax | 586-900-2101
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Provider Business Mailing Address
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Address Line | 33900 HARPER AVE STE 104
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City | CLINTON TWP
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State | MI
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Zip | 48035-4258
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Country | US
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Telephone | 586-350-2644
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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 | 225100000X
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Taxonomy Name | Physical Therapist
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License Number | 5501302426
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License Number State | MI
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