MEDICARE: CURTIS JEVENS P.T.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	225100000X	Physical Therapist	5501008796	MI

General Provider Information

NPI Number	:	1174787006
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	CURTIS JEVENS P.T.

Provider Business Mailing Address
First Line	:	1652 STONE ST
Second Line	:
City	:	PORT HURON
State	:	MI
Zip	:	48060-3344
Country	:	US
Telephone Number	:	810-982-6200
Fax Number	:

Provider Business Practice Location Address
First Line	:	1652 STONE ST
Second Line	:
City	:	PORT HURON
State	:	MI
Zip	:	48060-3344
Country	:	US
Telephone Number	:	810-982-6200
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	07/10/2008
Last Update Date	:	07/10/2008

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