Provider Demographics
NPI:1871618017
Name:ANDERSON, JAMI TEMPLE (PT, DPT, AT, AT,C)
Entity type:Individual
Prefix:MS
First Name:JAMI
Middle Name:TEMPLE
Last Name:ANDERSON
Suffix:
Gender:F
Credentials:PT, DPT, AT, AT,C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:854 WASHINGTON AVE STE 200
Mailing Address - Street 2:
Mailing Address - City:HOLLAND
Mailing Address - State:MI
Mailing Address - Zip Code:49423-7143
Mailing Address - Country:US
Mailing Address - Phone:810-577-7224
Mailing Address - Fax:
Practice Address - Street 1:854 WASHINGTON AVE STE 200
Practice Address - Street 2:
Practice Address - City:HOLLAND
Practice Address - State:MI
Practice Address - Zip Code:49423-7143
Practice Address - Country:US
Practice Address - Phone:616-392-9430
Practice Address - Fax:616-392-5257
Is Sole Proprietor?:No
Enumeration Date:2007-03-20
Last Update Date:2023-02-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI26010006852255A2300X
MI5501015752225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
No2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer