Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 2251G0304X | Physical Therapist - Geriatrics | 5501016767 | MI |
NPI | 1144859810 |
---|---|
Provider Name | Kendyll Lynn Stevens |
First Address | Caledonia, MI 49316-8359 |
Second Address | Hastings, MI 49058-1026 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 05/04/2020 |
Last Update Date | 05/04/2020 |