Provider Demographics
NPI:1073687117
Name:SCHRAUBEN, KRISTIN C (PT)
Entity Type:Individual
Prefix:MRS
First Name:KRISTIN
Middle Name:C
Last Name:SCHRAUBEN
Suffix:
Gender:F
Credentials:PT
Other - Prefix:MS
Other - First Name:KRISTIN
Other - Middle Name:C
Other - Last Name:WELLER
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:PT
Mailing Address - Street 1:1377 MOTOR PKWY
Mailing Address - Street 2:STE 307
Mailing Address - City:ISLANDIA
Mailing Address - State:NY
Mailing Address - Zip Code:11749-5258
Mailing Address - Country:US
Mailing Address - Phone:616-522-0066
Mailing Address - Fax:616-527-1667
Practice Address - Street 1:3751 S STATE RD
Practice Address - Street 2:
Practice Address - City:IONIA
Practice Address - State:MI
Practice Address - Zip Code:48846
Practice Address - Country:US
Practice Address - Phone:616-522-0066
Practice Address - Fax:616-527-1667
Is Sole Proprietor?:No
Enumeration Date:2006-11-20
Last Update Date:2020-09-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5501012502225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI0N23930008Medicare ID - Type Unspecified