Provider Demographics
NPI:1639554777
Name:KINGSBURY, NANCY LEE (PT)
Entity Type:Individual
Prefix:MS
First Name:NANCY
Middle Name:LEE
Last Name:KINGSBURY
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 1:10880 W M 28
Mailing Address - Street 2:PO BOX 477
Mailing Address - City:BRIMLEY
Mailing Address - State:MI
Mailing Address - Zip Code:49715-9212
Mailing Address - Country:US
Mailing Address - Phone:906-748-1128
Mailing Address - Fax:
Practice Address - Street 1:2120 43RD ST SE
Practice Address - Street 2:SUITE 100
Practice Address - City:GRAND RAPIDS
Practice Address - State:MI
Practice Address - Zip Code:49508-3772
Practice Address - Country:US
Practice Address - Phone:616-281-1144
Practice Address - Fax:616-281-1221
Is Sole Proprietor?:No
Enumeration Date:2015-07-29
Last Update Date:2015-07-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5501005144225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist