MEDICARE: JENNAFER KHOURY PT, 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	5501304148	MI

General Provider Information

NPI Number	:	1679431860
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JENNAFER KHOURY PT, DPT

Provider Business Mailing Address
First Line	:	8665 GROVE ST
Second Line	:
City	:	WASHINGTON
State	:	MI
Zip	:	48094-3614
Country	:	US
Telephone Number	:	586-788-7107
Fax Number	:	586-371-2037

Provider Business Practice Location Address
First Line	:	6785 23 MILE RD
Second Line	:
City	:	SHELBY TOWNSHIP
State	:	MI
Zip	:	48316-4414
Country	:	US
Telephone Number	:	586-788-7107
Fax Number	:	586-371-2037

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

Provider Enumeration Date	:	01/14/2026
Last Update Date	:	01/14/2026

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