Organization
SCOLIOASIS, LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MRS. JENNIE BIRK MAYNARD P.T. (PHYSICAL THERAPIST)
(734) 253-2528
Entity
Organization
Contact information
Practice address
8089 MAIN ST STE 3, DEXTER, MI 48130-1079
(734) 253-2528
Mailing address
8089 MAIN ST STE 3, DEXTER, MI 48130-1079
(734) 253-2528
Taxonomy
Speciality
Code
Description
License number
State
261QP2000X
Physical Therapy Clinic/Center
Primary
5501001826
MI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1316273857
TYPE 1 NPI
MI
Enumeration date
01/07/2010
Last updated
02/28/2017
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