Basic Information
Provider Information
NPI: 1487065686
EntityType: 1
ReplacementNPI:  
OrganizationName:  
LastName: JOYCE
FirstName: JANELLE
MiddleName:  
NamePrefix:  
NameSuffix:  
Credential:  
OtherOrganizationName:  
OtherOrganizationType:  
OtherLastName: HELDT
OtherFirstName: JANELLE
OtherMiddleName:  
OtherNamePrefix:  
OtherNameSuffix:  
OtherCredential:  
OtherLastNameType: 1
Mailing Information
Address1: 9368 N LILLEY RD
Address2:  
City: PLYMOUTH
State: MI
PostalCode: 481704610
CountryCode: US
TelephoneNumber:  
FaxNumber:  
Practice Location
Address1: 9368 N LILLEY RD
Address2:  
City: PLYMOUTH
State: MI
PostalCode: 481704610
CountryCode: US
TelephoneNumber: 7344163900
FaxNumber:  
Other Information
ProviderEnumerationDate: 05/12/2014
LastUpdateDate: 03/11/2020
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode: F
AuthorizedOfficialLastName:  
AuthorizedOfficialFirstName:  
AuthorizedOfficialMiddleName:  
AuthorizedOfficialTitleorPosition:  
AuthorizedOfficialTelephone:  
IsSoleProprietor: Y
IsOrganizationSubpart:  
ParentOrganizationLBN:  
AuthorizedOfficialNamePrefix:  
AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential:  
NPICertificationDate: 03/11/2020

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
225100000X  Y Respiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist 

No ID Information.


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