Active NPI
Tracey Lenn Jarvis
- Physical Therapist
- Plymouth, MI
National Provider Identifier
1497024715
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Physical Therapist
- License
- 1297
- Practice address
- 705 S Main St Ste 220
Plymouth, MI 48170-5436 - Phone
- (866) 874-0036
- NPI assigned
- Dec 15, 2011
- Sex
- Male
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Physical Therapist | 225100000X | 1297 | AR | Primary |
Addresses
Primary practice location
705 S Main St Ste 220
Plymouth, MI 48170-5436
Mailing address
705 S Main St Ste 220
Plymouth, MI 48170-5436
Phone (866) 874-0036
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 1922 | OK | MD | Clinical Social Worker |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1323907200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1323907200000",
"number": "1497024715",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "705 S MAIN ST STE 220",
"city": "PLYMOUTH",
"state": "MI",
"postal_code": "481705436",
"telephone_number": "866-874-0036"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "705 S MAIN ST STE 220",
"city": "PLYMOUTH",
"state": "MI",
"postal_code": "481705436",
"telephone_number": "866-874-0036"
}
],
"practiceLocations": [],
"basic": {
"last_name": "JARVIS",
"first_name": "TRACEY",
"middle_name": "LENN",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2011-12-15",
"last_updated": "2011-12-15",
"status": "A"
},
"taxonomies": [
{
"code": "225100000X",
"taxonomy_group": "",
"desc": "Physical Therapist",
"state": "AR",
"license": "1297",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Plymouth, MI
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 15, 2011; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.