Provider Demographics
NPI:1396237996
Name:WOODRUFF, JANELLE DENISE (PT)
Entity type:Individual
Prefix:
First Name:JANELLE
Middle Name:DENISE
Last Name:WOODRUFF
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:42005 W 12 MILE RD
Mailing Address - Street 2:
Mailing Address - City:NOVI
Mailing Address - State:MI
Mailing Address - Zip Code:48377-3113
Mailing Address - Country:US
Mailing Address - Phone:248-305-7551
Mailing Address - Fax:248-305-7555
Practice Address - Street 1:42005 W 12 MILE RD
Practice Address - Street 2:
Practice Address - City:NOVI
Practice Address - State:MI
Practice Address - Zip Code:48377-3113
Practice Address - Country:US
Practice Address - Phone:248-305-7551
Practice Address - Fax:248-305-7555
Is Sole Proprietor?:No
Enumeration Date:2018-05-31
Last Update Date:2018-05-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5501010478225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist