Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225100000X | Physical Therapist | 5501002670 | MI |
N | 2251X0800X | Physical Therapist - Orthopedic | 5501002670 | MI |
NPI | 1083261259 |
---|---|
Provider Name | Curtis Kendall Leibbrand |
First Address | Kalamazoo, MI 49009-7476 |
Second Address | Kalamazoo, MI 49009-7476 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 22/08/2019 |
Last Update Date | 22/08/2019 |