Provider Demographics
NPI:1124608450
Name:VOHS, JEFFREY ALLAN (PTA)
Entity type:Individual
Prefix:
First Name:JEFFREY
Middle Name:ALLAN
Last Name:VOHS
Suffix:
Gender:M
Credentials:PTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:52549 RAVENS LN
Mailing Address - Street 2:
Mailing Address - City:CHESTERFIELD
Mailing Address - State:MI
Mailing Address - Zip Code:48047-3540
Mailing Address - Country:US
Mailing Address - Phone:586-904-1247
Mailing Address - Fax:
Practice Address - Street 1:52549 RAVENS LN
Practice Address - Street 2:
Practice Address - City:CHESTERFIELD
Practice Address - State:MI
Practice Address - Zip Code:48047-3540
Practice Address - Country:US
Practice Address - Phone:586-904-1247
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-04-12
Last Update Date:2021-04-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5502000164225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant