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NPI Code Detail

MEDICARE: MRS. JENNIFER GUSHIKEN PTA

MEDICARE: MRS. JENNIFER GUSHIKEN PTA
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
1225200000XPhysical Therapy Assistant5502001003MI

General Provider Information

NPI Number : 1700371754
Entity Type Code : Individual
Provider Name (Legal Business Name) : MRS. JENNIFER GUSHIKEN PTA
Provider Business Mailing Address
First Line : 572 SUNMEADOW DR SE
Second Line :
City : GRAND RAPIDS
State : MI
Zip : 49508-7709
Country : US
Telephone Number :
Fax Number :
Provider Business Practice Location Address
First Line : 3400 WILSON AVE SW
Second Line :
City : GRANDVILLE
State : MI
Zip : 49418-1854
Country : US
Telephone Number : 616-534-5487
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 06/22/2018
Last Update Date : 06/22/2018

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