Provider Demographics
NPI:1437872892
Name:KBT PAIN MANAGEMENT & RECOVERY
Entity Type:Organization
Organization Name:KBT PAIN MANAGEMENT & RECOVERY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MRS
Authorized Official - First Name:KAREN
Authorized Official - Middle Name:MARIE
Authorized Official - Last Name:BLAISDELL-THOMAS
Authorized Official - Suffix:
Authorized Official - Credentials:LMT
Authorized Official - Phone:586-255-7471
Mailing Address - Street 1:57424 MEGAN DR
Mailing Address - Street 2:
Mailing Address - City:WASHINGTON
Mailing Address - State:MI
Mailing Address - Zip Code:48094-3816
Mailing Address - Country:US
Mailing Address - Phone:586-255-7471
Mailing Address - Fax:586-745-7388
Practice Address - Street 1:57424 MEGAN DR
Practice Address - Street 2:
Practice Address - City:WASHINGTON
Practice Address - State:MI
Practice Address - Zip Code:48094-3816
Practice Address - Country:US
Practice Address - Phone:586-255-7471
Practice Address - Fax:586-745-7388
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-09-21
Last Update Date:2022-09-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage TherapistGroup - Single Specialty