Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225100000X | Physical Therapist | 550102909 | MI |
NPI | 1003318783 |
---|---|
Provider Name | Katharine Lind Thompson |
First Address | Jenison, MI 49428-8725 |
Second Address | Grand Rapids, MI 49503-4502 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 08/03/2018 |
Last Update Date | 08/03/2018 |