Provider Demographics
NPI:1568964377
Name:SIMPSON, KATHLEEN SUE KNOPF (PT, CHT)
Entity Type:Individual
Prefix:
First Name:KATHLEEN
Middle Name:SUE KNOPF
Last Name:SIMPSON
Suffix:
Gender:F
Credentials:PT, CHT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6105 WILSON AVE SW
Mailing Address - Street 2:
Mailing Address - City:WYOMING
Mailing Address - State:MI
Mailing Address - Zip Code:49418-9714
Mailing Address - Country:US
Mailing Address - Phone:616-486-5055
Mailing Address - Fax:616-486-5201
Practice Address - Street 1:6105 WILSON AVE SW
Practice Address - Street 2:
Practice Address - City:WYOMING
Practice Address - State:MI
Practice Address - Zip Code:49418-9714
Practice Address - Country:US
Practice Address - Phone:616-486-5055
Practice Address - Fax:616-486-5201
Is Sole Proprietor?:No
Enumeration Date:2018-03-07
Last Update Date:2018-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5501002583225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI5501002583OtherBOARD OF PHYSICAL THERAPY LICENSURE