Provider Demographics
NPI:1447402607
Name:STORHOK, KERI LYN (DPT)
Entity Type:Individual
Prefix:
First Name:KERI
Middle Name:LYN
Last Name:STORHOK
Suffix:
Gender:F
Credentials:DPT
Other - Prefix:
Other - First Name:KERI
Other - Middle Name:LYN
Other - Last Name:ANDERSON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DPT
Mailing Address - Street 1:3009 S BALDWIN RD
Mailing Address - Street 2:
Mailing Address - City:ORION
Mailing Address - State:MI
Mailing Address - Zip Code:48359-2362
Mailing Address - Country:US
Mailing Address - Phone:248-393-7707
Mailing Address - Fax:248-393-7708
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:248-393-7708
Is Sole Proprietor?:Yes
Enumeration Date:2008-10-21
Last Update Date:2010-09-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5501013694225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MIN26160015Medicare PIN