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General NPI Number Information
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NPI Number | 1891065538
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Entity Type | Individual
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Provider Name | JAIME GENDLIN DPT
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Gender | Female
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Dates
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Enumeration Date | 01/11/2012
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Last Update Date | 01/11/2012
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Provider Practice Location Address
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Address Line | 23411 GRATIOT AVE
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City | EASTPOINTE
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State | MI
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Zip | 48021-1644
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Country | US
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Telephone | 248-333-3335
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Fax | 248-333-0297
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Provider Business Mailing Address
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Address Line | 5688 MURPHY CT
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City | WARREN
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State | MI
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Zip | 48092-6336
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Country | US
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Telephone |
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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 | 261Q00000X
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Taxonomy Name | Clinic/Center
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License Number | 5501015769
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License Number State | MI
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