Provider Demographics
NPI:1073761359
Name:KLEIVER, KARENA SUZANNE (PT)
Entity Type:Individual
Prefix:
First Name:KARENA
Middle Name:SUZANNE
Last Name:KLEIVER
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:KARENA
Other - Middle Name:SUZANNE
Other - Last Name:GURD
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PT
Mailing Address - Street 1:3924 CHEYENNE DR SW
Mailing Address - Street 2:
Mailing Address - City:GRANDVILLE
Mailing Address - State:MI
Mailing Address - Zip Code:49418-1893
Mailing Address - Country:US
Mailing Address - Phone:616-318-4616
Mailing Address - Fax:
Practice Address - Street 1:100 MICHIGAN ST NE
Practice Address - Street 2:
Practice Address - City:GRAND RAPIDS
Practice Address - State:MI
Practice Address - Zip Code:49503-2560
Practice Address - Country:US
Practice Address - Phone:616-391-1690
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-08-28
Last Update Date:2008-08-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5501010873225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist