Provider Demographics
NPI:1902082944
Name:GOMOS, JEANETTE M (PT)
Entity Type:Individual
Prefix:
First Name:JEANETTE
Middle Name:M
Last Name:GOMOS
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8390 E PITTSBURG RD
Mailing Address - Street 2:
Mailing Address - City:DURAND
Mailing Address - State:MI
Mailing Address - Zip Code:48429-1553
Mailing Address - Country:US
Mailing Address - Phone:989-288-3273
Mailing Address - Fax:
Practice Address - Street 1:8390 E PITTSBURG RD
Practice Address - Street 2:
Practice Address - City:DURAND
Practice Address - State:MI
Practice Address - Zip Code:48429-1553
Practice Address - Country:US
Practice Address - Phone:989-288-3273
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-01-19
Last Update Date:2008-02-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI003196225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist