Provider Demographics
NPI:1144564881
Name:BERMINGHAM, KENSEY CASE (DPT)
Entity type:Individual
Prefix:
First Name:KENSEY
Middle Name:CASE
Last Name:BERMINGHAM
Suffix:
Gender:M
Credentials:DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3138 OAK LN
Mailing Address - Street 2:
Mailing Address - City:STEVENSVILLE
Mailing Address - State:MI
Mailing Address - Zip Code:49127
Mailing Address - Country:US
Mailing Address - Phone:574-850-6638
Mailing Address - Fax:269-934-5054
Practice Address - Street 1:501 GRAHAM AVE
Practice Address - Street 2:
Practice Address - City:BENTON HARBOR
Practice Address - State:MI
Practice Address - Zip Code:49022-3626
Practice Address - Country:US
Practice Address - Phone:574-850-6638
Practice Address - Fax:269-934-5054
Is Sole Proprietor?:No
Enumeration Date:2012-11-19
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5501016121225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist