Provider Demographics
NPI:1225233273
Name:KKS OF MICHIGAN LLC
Entity Type:Organization
Organization Name:KKS OF MICHIGAN LLC
Other - Org Name:HEALTHQUEST PHYSICAL THERAPY & WELLNESS
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:JULIE
Authorized Official - Middle Name:
Authorized Official - Last Name:MARTEL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:248-601-9207
Mailing Address - Street 1:1773 STAR BATT DR
Mailing Address - Street 2:
Mailing Address - City:ROCHESTER HILLS
Mailing Address - State:MI
Mailing Address - Zip Code:48309-3708
Mailing Address - Country:US
Mailing Address - Phone:248-601-9207
Mailing Address - Fax:
Practice Address - Street 1:3009 S BALDWIN RD
Practice Address - Street 2:
Practice Address - City:ORION
Practice Address - State:MI
Practice Address - Zip Code:48359-2362
Practice Address - Country:US
Practice Address - Phone:248-393-7707
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-06-19
Last Update Date:2023-01-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI261QP2000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2000XAmbulatory Health Care FacilitiesClinic/CenterPhysical Therapy
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI0F35850OtherBLUE CROSS BLUE SHIELD OF MICHIGAN
MI5870183OtherAETNA
MI0F35850OtherBLUE CROSS BLUE SHIELD OF MICHIGAN