Individual
JORDAN DEFEVER
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Contact information
Practice address
893 E SUPERIOR ST, WAYLAND, MI 49348-9178
(616) 252-3433
Mailing address
2780 ROYAL VISTA CT NW APT 201, GRAND RAPIDS, MI 49534-2619
Taxonomy
Speciality
Code
Description
License number
State
225100000X
Physical Therapist
Primary
5501018190
MI
Other
Enumeration date
06/13/2017
Last updated
03/17/2018
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