Provider Demographics
NPI:1558826479
Name:KIRKBRIDE, KHRISTINE MARIE (DPT, OMPT)
Entity Type:Individual
Prefix:
First Name:KHRISTINE
Middle Name:MARIE
Last Name:KIRKBRIDE
Suffix:
Gender:F
Credentials:DPT, OMPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2380 CEDAR ST STE 203
Mailing Address - Street 2:
Mailing Address - City:HOLT
Mailing Address - State:MI
Mailing Address - Zip Code:48842-2211
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:3315 E MICHIGAN AVE STE 6
Practice Address - Street 2:
Practice Address - City:LANSING
Practice Address - State:MI
Practice Address - Zip Code:48912-4600
Practice Address - Country:US
Practice Address - Phone:517-709-4677
Practice Address - Fax:517-798-5667
Is Sole Proprietor?:No
Enumeration Date:2019-02-05
Last Update Date:2021-08-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5501019053225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist