MEDICARE: MRS. JESSICA LYNNE HALVERSON DPT

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	5501015830	MI

General Provider Information

NPI Number	:	1609149129
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. JESSICA LYNNE HALVERSON DPT

Provider Business Mailing Address
First Line	:	33900 HARPER AVE
Second Line	:	SUITE 104
City	:	CLINTON TOWNSHIP
State	:	MI
Zip	:	48035-4258
Country	:	US
Telephone Number	:	586-416-9100
Fax Number	:	586-416-9103

Provider Business Practice Location Address
First Line	:	50174 SCHOENHERR RD
Second Line	:
City	:	SHELBY TOWNSHIP
State	:	MI
Zip	:	48315-3136
Country	:	US
Telephone Number	:	586-884-5040
Fax Number	:	586-580-0375

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

Provider Enumeration Date	:	02/14/2012
Last Update Date	:	02/07/2025

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