Provider Demographics
NPI:1225699135
Name:KLINTWORTH, AMY KRISTINE
Entity Type:Individual
Prefix:
First Name:AMY
Middle Name:KRISTINE
Last Name:KLINTWORTH
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:AMY
Other - Middle Name:
Other - Last Name:MEADE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:19205 GLENDALE CIR
Mailing Address - Street 2:
Mailing Address - City:SPRING LAKE
Mailing Address - State:MI
Mailing Address - Zip Code:49456-2340
Mailing Address - Country:US
Mailing Address - Phone:616-402-2656
Mailing Address - Fax:
Practice Address - Street 1:19205 GLENDALE CIR
Practice Address - Street 2:
Practice Address - City:SPRING LAKE
Practice Address - State:MI
Practice Address - Zip Code:49456-2340
Practice Address - Country:US
Practice Address - Phone:616-402-2656
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-06-23
Last Update Date:2019-06-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5502005608208100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & Rehabilitation