Provider Demographics
NPI:1518184753
Name:GAINES, KATHY ANN (PT)
Entity Type:Individual
Prefix:
First Name:KATHY
Middle Name:ANN
Last Name:GAINES
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3751 BRIAR PARKWAY
Mailing Address - Street 2:
Mailing Address - City:ANN ARBOR
Mailing Address - State:MI
Mailing Address - Zip Code:48108-5905
Mailing Address - Country:US
Mailing Address - Phone:734-929-2478
Mailing Address - Fax:
Practice Address - Street 1:2775 BOARDWALK ST
Practice Address - Street 2:
Practice Address - City:ANN ARBOR
Practice Address - State:MI
Practice Address - Zip Code:48104-6713
Practice Address - Country:US
Practice Address - Phone:734-994-2303
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-19
Last Update Date:2007-08-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5501009463225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist