Provider Demographics
NPI:1407822513
Name:NIMTZ, KAI CHRISTOPHER (PT)
Entity Type:Individual
Prefix:MR
First Name:KAI
Middle Name:CHRISTOPHER
Last Name:NIMTZ
Suffix:
Gender:M
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3821 WACHTEL DR
Mailing Address - Street 2:
Mailing Address - City:HOLT
Mailing Address - State:MI
Mailing Address - Zip Code:48842-9783
Mailing Address - Country:US
Mailing Address - Phone:517-694-5113
Mailing Address - Fax:
Practice Address - Street 1:3536 MERIDIAN CROSSINGS
Practice Address - Street 2:SUITE 240
Practice Address - City:OKEMOS
Practice Address - State:MI
Practice Address - Zip Code:48864-4584
Practice Address - Country:US
Practice Address - Phone:517-347-2495
Practice Address - Fax:517-347-3540
Is Sole Proprietor?:No
Enumeration Date:2006-02-28
Last Update Date:2008-06-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI55010080902251X0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2251X0800XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistOrthopedic
Provider Identifiers
StateIdentifier IDID TypeIssuer
MIP07840001Medicare ID - Type Unspecified