Provider Demographics
NPI:1538199070
Name:CARRIER, KATHY LOU (PT)
Entity type:Individual
Prefix:MS
First Name:KATHY
Middle Name:LOU
Last Name:CARRIER
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6563 W MAIN ST
Mailing Address - Street 2:SUITE: LOWER LEVEL
Mailing Address - City:KALAMAZOO
Mailing Address - State:MI
Mailing Address - Zip Code:49009-4051
Mailing Address - Country:US
Mailing Address - Phone:269-488-3320
Mailing Address - Fax:269-372-6113
Practice Address - Street 1:6563 W MAIN ST
Practice Address - Street 2:SUITE: LOWER LEVEL
Practice Address - City:KALAMAZOO
Practice Address - State:MI
Practice Address - Zip Code:49009-4051
Practice Address - Country:US
Practice Address - Phone:269-488-3320
Practice Address - Fax:269-372-6113
Is Sole Proprietor?:No
Enumeration Date:2006-07-03
Last Update Date:2015-02-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5501002881225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI34790001Medicare PIN