=====================================================
General NPI Number Information
=====================================================
NPI Number | 1891396719
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | EMMA FENTZ DPT
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 11/06/2020
-----------------------------------------------------
Last Update Date | 05/22/2025
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 157 HOLIDAY PL
-----------------------------------------------------
City | FRANKLIN
-----------------------------------------------------
State | IN
-----------------------------------------------------
Zip | 46131-2622
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 463-222-2010
-----------------------------------------------------
Fax | 463-222-2011
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 33900 HARPER AVE STE 104
-----------------------------------------------------
City | CLINTON TWP
-----------------------------------------------------
State | MI
-----------------------------------------------------
Zip | 48035-4258
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 586-350-2644
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
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 | 05014000A
-----------------------------------------------------
License Number State | IN
-----------------------------------------------------