Provider Demographics
NPI:1447427679
Name:KLEIKAMP, AMY BETH (PTA)
Entity Type:Individual
Prefix:
First Name:AMY
Middle Name:BETH
Last Name:KLEIKAMP
Suffix:
Gender:F
Credentials:PTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1225 WOODWARD AVE
Mailing Address - Street 2:
Mailing Address - City:KINGSFORD
Mailing Address - State:MI
Mailing Address - Zip Code:49802-4312
Mailing Address - Country:US
Mailing Address - Phone:906-774-4805
Mailing Address - Fax:
Practice Address - Street 1:1225 WOODWARD AVE
Practice Address - Street 2:
Practice Address - City:KINGSFORD
Practice Address - State:MI
Practice Address - Zip Code:49802-4312
Practice Address - Country:US
Practice Address - Phone:906-774-4805
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-05-16
Last Update Date:2008-07-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI545-019225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant