Individual
JOLENE LARAE BENNETT
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PT
Contact information
Practice address
3540 FAIRLANES AVE SW, GRANDVILLE, MI 49418-1536
(616) 531-0464
(616) 531-3651
Mailing address
3540 FAIRLANES AVE SW, GRANDVILLE, MI 49418-1536
(616) 531-0464
(616) 531-3651
Taxonomy
Speciality
Code
Description
License number
State
2251X0800X
Orthopedic Physical Therapist
Primary
5501003994
MI
Other
Enumeration date
05/11/2021
Last updated
05/11/2021
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