Provider Demographics
NPI:1114104601
Name:KLATY, MICHELLE KRISTIN (DPT)
Entity Type:Individual
Prefix:DR
First Name:MICHELLE
Middle Name:KRISTIN
Last Name:KLATY
Suffix:
Gender:F
Credentials:DPT
Other - Prefix:DR
Other - First Name:MICHELLE
Other - Middle Name:KRISTIN
Other - Last Name:BROSTROM
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DPT
Mailing Address - Street 1:3200E EISENHOWER PKWY
Mailing Address - Street 2:
Mailing Address - City:ANN ARBOR
Mailing Address - State:MI
Mailing Address - Zip Code:48108-3231
Mailing Address - Country:US
Mailing Address - Phone:734-677-0070
Mailing Address - Fax:734-677-0890
Practice Address - Street 1:1478 SAND PIPER DR
Practice Address - Street 2:
Practice Address - City:GRAND BLANC
Practice Address - State:MI
Practice Address - Zip Code:48439-7244
Practice Address - Country:US
Practice Address - Phone:810-210-5391
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-01-27
Last Update Date:2015-08-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5501011508225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist