=====================================================
General NPI Number Information
=====================================================
NPI Number | 1568619989
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | JENNIFER LYNN BAILEY DPT
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 08/27/2008
-----------------------------------------------------
Last Update Date | 08/27/2008
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 1235 S CENTER RD UNIT 12
-----------------------------------------------------
City | BURTON
-----------------------------------------------------
State | MI
-----------------------------------------------------
Zip | 48509-1700
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 810-743-8820
-----------------------------------------------------
Fax | 810-743-5908
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 1235 S CENTER RD UNIT 12
-----------------------------------------------------
City | BURTON
-----------------------------------------------------
State | MI
-----------------------------------------------------
Zip | 48509-1700
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 810-743-8820
-----------------------------------------------------
Fax | 810-743-5908
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 225100000X
-----------------------------------------------------
Taxonomy Name | Physical Therapist
-----------------------------------------------------
License Number | 5501013991
-----------------------------------------------------
License Number State | MI
-----------------------------------------------------