Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225200000X | Physical Therapy Assistant |
NPI | 1003498221 |
---|---|
Provider Name | Kevin Kinney |
First Address | Shelby Township, MI 48315-5024 |
Second Address | Shelby Township, MI 48315-5024 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 27/04/2021 |
Last Update Date | 27/04/2021 |