Provider Demographics
NPI:1801170824
Name:DUSH, KATHRYN A (DPT)
Entity type:Individual
Prefix:
First Name:KATHRYN
Middle Name:A
Last Name:DUSH
Suffix:
Gender:F
Credentials:DPT
Other - Prefix:
Other - First Name:KATHRYN
Other - Middle Name:A
Other - Last Name:REITH
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DPT
Mailing Address - Street 1:4401 CAMPUS RIDGE DR STE 1000
Mailing Address - Street 2:
Mailing Address - City:MIDLAND
Mailing Address - State:MI
Mailing Address - Zip Code:48640-6125
Mailing Address - Country:US
Mailing Address - Phone:989-837-9100
Mailing Address - Fax:989-837-9105
Practice Address - Street 1:4401 CAMPUS RIDGE DR STE 1000
Practice Address - Street 2:
Practice Address - City:MIDLAND
Practice Address - State:MI
Practice Address - Zip Code:48640-6125
Practice Address - Country:US
Practice Address - Phone:989-837-9100
Practice Address - Fax:989-837-9105
Is Sole Proprietor?:No
Enumeration Date:2011-10-10
Last Update Date:2020-04-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL070018798225100000X
MI5501016232225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL1801170824OtherNPI
ILIL2993022Medicare PIN
IL202845214Medicare PIN