Provider Demographics
NPI:1033296470
Name:PIEPENBROK, KATHI
Entity Type:Individual
Prefix:
First Name:KATHI
Middle Name:
Last Name:PIEPENBROK
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:23161 GREATER MACK AVE
Mailing Address - Street 2:
Mailing Address - City:SAINT CLAIR SHORES
Mailing Address - State:MI
Mailing Address - Zip Code:48080-1956
Mailing Address - Country:US
Mailing Address - Phone:586-779-8892
Mailing Address - Fax:586-779-2869
Practice Address - Street 1:23161 GREATER MACK AVE
Practice Address - Street 2:
Practice Address - City:SAINT CLAIR SHORES
Practice Address - State:MI
Practice Address - Zip Code:48080-1956
Practice Address - Country:US
Practice Address - Phone:586-779-8892
Practice Address - Fax:586-779-2869
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-01
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5501001606225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist