Provider Demographics
NPI:1558855668
Name:TENNANT, KRISTINA MICHELLE (OTR/MPT)
Entity Type:Individual
Prefix:
First Name:KRISTINA
Middle Name:MICHELLE
Last Name:TENNANT
Suffix:
Gender:F
Credentials:OTR/MPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
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Mailing Address - Street 1:1215 E MICHIGAN AVE
Mailing Address - Street 2:
Mailing Address - City:LANSING
Mailing Address - State:MI
Mailing Address - Zip Code:48912-1811
Mailing Address - Country:US
Mailing Address - Phone:517-364-3375
Mailing Address - Fax:517-485-1961
Practice Address - Street 1:1215 E MICHIGAN AVE FL 6
Practice Address - Street 2:
Practice Address - City:LANSING
Practice Address - State:MI
Practice Address - Zip Code:48912-1811
Practice Address - Country:US
Practice Address - Phone:517-364-3375
Practice Address - Fax:517-485-1961
Is Sole Proprietor?:Yes
Enumeration Date:2018-06-21
Last Update Date:2018-06-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5501009229225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist