Provider Demographics
NPI:1588264451
Name:ORLANDO, JEREMY CHARLES (PT, DPT)
Entity type:Individual
Prefix:DR
First Name:JEREMY
Middle Name:CHARLES
Last Name:ORLANDO
Suffix:
Gender:M
Credentials:PT, DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2095 MERRILL ST
Mailing Address - Street 2:
Mailing Address - City:YPSILANTI
Mailing Address - State:MI
Mailing Address - Zip Code:48197-4421
Mailing Address - Country:US
Mailing Address - Phone:734-546-7005
Mailing Address - Fax:
Practice Address - Street 1:6014 W MAPLE RD
Practice Address - Street 2:
Practice Address - City:WEST BLOOMFIELD
Practice Address - State:MI
Practice Address - Zip Code:48322-2212
Practice Address - Country:US
Practice Address - Phone:248-985-7500
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-10-29
Last Update Date:2020-10-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5501019799225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist