Individual
ELISE MAYNARD
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PT, DPT
Contact information
Practice address
2040 AURELIUS RD, HOLT, MI 48842-1367
(517) 268-9040
(517) 268-9042
Mailing address
3073 SHIRLEY DR, JACKSON, MI 49201-7010
(517) 990-6210
(517) 990-6212
Taxonomy
Speciality
Code
Description
License number
State
225100000X
Physical Therapist
Primary
5501021595
MI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
0C33104
BCBS
MI
01
—
5501021595
STATE LICENSE
MI
Enumeration date
11/17/2021
Last updated
02/10/2025
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