Basic Information
| Provider Information | |||||||||
| NPI: | 1396930822 | ||||||||
| EntityType: | 1 | ||||||||
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| LastName: | CHRISTMAN | ||||||||
| FirstName: | JACALYN | ||||||||
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| Mailing Information | |||||||||
| Address1: | 107 BEE HIVE TRL LOT 207 | ||||||||
| Address2: | |||||||||
| City: | HOLLISTER | ||||||||
| State: | MO | ||||||||
| PostalCode: | 656725744 | ||||||||
| CountryCode: | US | ||||||||
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| Practice Location | |||||||||
| Address1: | 27240 HAGGERTY RD | ||||||||
| Address2: | E-15 | ||||||||
| City: | FARMINGTON HILLS | ||||||||
| State: | MI | ||||||||
| PostalCode: | 483315716 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8669910900 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 09/07/2007 | ||||||||
| LastUpdateDate: | 09/07/2007 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 225200000X | 06001666A | IN | Y | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Physical Therapy Assistant | 225200000X | 2002013877 | MO | N | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Physical Therapy Assistant |
No ID Information.