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Individual

JODI CHARLES

Active
Sole proprietor
No

Provider details

NPI number
Gender
F
Credential
PTA

Contact information

Practice address
3240 W SILVER LAKE RD, FENTON, MI 48430-1374
(810) 714-4616
Mailing address
3240 W SILVER LAKE RD, FENTON, MI 48430-1374
(810) 714-4616

Taxonomy

Speciality
Code
Description
License number
State
225200000X
Physical Therapy Assistant
Primary
5502004673
MI

Other

Enumeration date
08/20/2015
Last updated
08/20/2015
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