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General NPI Number Information
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NPI Number | 1740925965
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Entity Type | Individual
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Provider Name | JAIME CANADA PTA
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Gender | Female
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Dates
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Enumeration Date | 05/02/2022
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Last Update Date | 04/10/2025
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Provider Practice Location Address
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Address Line | 44670 ANN ARBOR RD W STE 140
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City | PLYMOUTH
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State | MI
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Zip | 48170-3962
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Country | US
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Telephone | 734-673-8545
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Fax |
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Provider Business Mailing Address
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Address Line | 10601 BAKER AVE SE
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City | ALTO
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State | MI
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Zip | 49302-9619
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Country | US
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Telephone | 616-401-4794
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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 |
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License Number State | MI
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