Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225100000X | Physical Therapist | 5501015360 | MI |
N | 2251X0800X | Physical Therapist - Orthopedic | 5501015360 | MI |
NPI | 1063766491 |
---|---|
Provider Name | Kevin Michael Hecksel |
First Address | Grand Rapids, MI 49534-6300 |
Second Address | Grand Rapids, MI 49534-6300 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 07/11/2012 |
Last Update Date | 06/07/2018 |