Provider Demographics
NPI:1194439620
Name:SWINEHART, JENNIFER (ATC, COF)
Entity type:Individual
Prefix:
First Name:JENNIFER
Middle Name:
Last Name:SWINEHART
Suffix:
Gender:F
Credentials:ATC, COF
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3187 TURNBERRY DR
Mailing Address - Street 2:
Mailing Address - City:WHITE LAKE
Mailing Address - State:MI
Mailing Address - Zip Code:48383-3948
Mailing Address - Country:US
Mailing Address - Phone:248-818-7369
Mailing Address - Fax:
Practice Address - Street 1:525 N MAIN ST STE 270
Practice Address - Street 2:
Practice Address - City:MILFORD
Practice Address - State:MI
Practice Address - Zip Code:48381-1595
Practice Address - Country:US
Practice Address - Phone:248-378-1333
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-01-10
Last Update Date:2023-01-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI225000000X
MI08950255572255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer
No225000000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOrthotic Fitter