Provider Demographics
NPI:1841161163
Name:HOUSE, JAMIL T JR
Entity type:Individual
Prefix:
First Name:JAMIL
Middle Name:T
Last Name:HOUSE
Suffix:JR
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2600 PINE SHORE DR
Mailing Address - Street 2:
Mailing Address - City:ADRIAN
Mailing Address - State:MI
Mailing Address - Zip Code:49221-1521
Mailing Address - Country:US
Mailing Address - Phone:734-747-0815
Mailing Address - Fax:
Practice Address - Street 1:2600 PINE SHORE DR
Practice Address - Street 2:
Practice Address - City:ADRIAN
Practice Address - State:MI
Practice Address - Zip Code:49221-1521
Practice Address - Country:US
Practice Address - Phone:734-726-0338
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-09-17
Last Update Date:2025-09-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI7501016627225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist