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Organization

GREAT LAKES PAIN AND INJURY CENTER

Active
Organization subpart
No

Provider details

NPI number
Authorized official
JAIMON JACOB PT (PHYSICAL THERAPIST)
(248) 809-2094
Entity
Organization

Contact information

Practice address
15565 NORTHLAND DR., SUITE 103 W, SOUTHFIELD, MI 48075
(248) 809-2094
Mailing address
15565 NORTHLAND DR., SUITE 103 W, SOUTHFIELD, MI 48075
(248) 809-2094

Taxonomy

Speciality
Code
Description
License number
State
261QP2000X
Physical Therapy Clinic/Center
Primary
5501013218
MI

Other

Enumeration date
01/13/2017
Last updated
01/13/2017
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