Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 2251H1200X | Hand | 05004111A | IN |
Y | 2251X0800X | Physical Therapist - Orthopedic | 05004111A | IN |
NPI | 1831583996 |
---|---|
Provider Name | Kristin Marie Kabele |
First Address | South Bend, IN 46617-1924 |
Second Address | South Bend, IN 46614-2845 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 26/03/2015 |
Last Update Date | 31/03/2021 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
200441500 | (05) | IN |