Provider Demographics
NPI:1063581643
Name:BAUMANN, JENNIFER LYNN (PT, ATC)
Entity type:Individual
Prefix:MRS
First Name:JENNIFER
Middle Name:LYNN
Last Name:BAUMANN
Suffix:
Gender:F
Credentials:PT, ATC
Other - Prefix:
Other - First Name:JENNIFER
Other - Middle Name:LYNN
Other - Last Name:KRIPS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PT, ATC
Mailing Address - Street 1:133 W MAIN ST
Mailing Address - Street 2:#120
Mailing Address - City:NORTHVILLE
Mailing Address - State:MI
Mailing Address - Zip Code:48167-1520
Mailing Address - Country:US
Mailing Address - Phone:248-347-1168
Mailing Address - Fax:248-347-1252
Practice Address - Street 1:133 W MAIN ST
Practice Address - Street 2:#120
Practice Address - City:NORTHVILLE
Practice Address - State:MI
Practice Address - Zip Code:48167-1520
Practice Address - Country:US
Practice Address - Phone:248-347-1168
Practice Address - Fax:248-347-1252
Is Sole Proprietor?:No
Enumeration Date:2006-11-07
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5501010445225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist