Provider Demographics
NPI:1497295471
Name:HEPNER, KRISTINE (DPT)
Entity Type:Individual
Prefix:
First Name:KRISTINE
Middle Name:
Last Name:HEPNER
Suffix:
Gender:F
Credentials:DPT
Other - Prefix:
Other - First Name:KRISTINE
Other - Middle Name:
Other - Last Name:KASSL
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DPT
Mailing Address - Street 1:33900 HARPER AVE STE 104
Mailing Address - Street 2:
Mailing Address - City:CLINTON TWP
Mailing Address - State:MI
Mailing Address - Zip Code:48035-4258
Mailing Address - Country:US
Mailing Address - Phone:586-350-2644
Mailing Address - Fax:586-350-2644
Practice Address - Street 1:856 N SUPERIOR DR
Practice Address - Street 2:
Practice Address - City:CROWN POINT
Practice Address - State:IN
Practice Address - Zip Code:46307
Practice Address - Country:US
Practice Address - Phone:219-213-3942
Practice Address - Fax:219-213-3943
Is Sole Proprietor?:No
Enumeration Date:2017-02-24
Last Update Date:2021-01-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL070023106225100000X
IN05013235A225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist