Provider Demographics
NPI:1316273857
Name:MAYNARD, JENNIE BIRK (PT)
Entity type:Individual
Prefix:MRS
First Name:JENNIE
Middle Name:BIRK
Last Name:MAYNARD
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:213 QUIET CREEK CT
Mailing Address - Street 2:
Mailing Address - City:CHELSEA
Mailing Address - State:MI
Mailing Address - Zip Code:48118-9455
Mailing Address - Country:US
Mailing Address - Phone:734-355-3035
Mailing Address - Fax:734-548-8289
Practice Address - Street 1:213 QUIET CREEK CT
Practice Address - Street 2:
Practice Address - City:CHELSEA
Practice Address - State:MI
Practice Address - Zip Code:48118
Practice Address - Country:US
Practice Address - Phone:734-355-3035
Practice Address - Fax:734-548-8289
Is Sole Proprietor?:Yes
Enumeration Date:2009-10-18
Last Update Date:2018-06-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5501001826225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist