Maija Matintytar Fenner
Individual provider Active NPI Physical Therapist · Croswell, MI
NPI 1972023471 · NPPES record last updated Jun 26, 2017
Key facts
- NPI
- 1972023471
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Physical Therapist 225100000X
- License
- 5501013810 (MI)
- Practice address
- 6512 Wellman Line Rd
Croswell, MI 48422-9120 - Phone
- (810) 278-7514
- NPI assigned
- Jun 26, 2017
- Sex
- Female
- Sole proprietor
- No
Medicare participation
- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
- Medicare enrollment (NPD)
- No
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 5501013810 | MI | MD | Physical Therapist |
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Physical Therapist | 225100000X | 5501013810 | MI | Yes |
Addresses
Primary practice location
6512 Wellman Line Rd
Croswell, MI 48422-9120
Mailing address
6512 Wellman Line Rd
Croswell, MI 48422-9120
Other providers in Croswell, MI
- Jonathan Sison Del Rosario
- Ehardt'S Advanced Care Pharmacy & Medical Supplies
- Ehardt'S Pharmacy Inc
- Raymond J Emond
- Carissa Fenner
- Samantha Lee Garcia
- Patrick Gonczar
- Julie Gordon
- Matthew Gormley
- Madison Griffith
All providers in Croswell, MI · Physical Therapist in Michigan
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Jun 26, 2017. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.