Provider Demographics
NPI:1740245232
Name:RIPPLE, KELLI LEE (PT)
Entity Type:Individual
Prefix:
First Name:KELLI
Middle Name:LEE
Last Name:RIPPLE
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:KELLI
Other - Middle Name:
Other - Last Name:KIME
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:505 E MICHIGAN AVE
Mailing Address - Street 2:
Mailing Address - City:SALINE
Mailing Address - State:MI
Mailing Address - Zip Code:48176-1588
Mailing Address - Country:US
Mailing Address - Phone:734-975-9100
Mailing Address - Fax:
Practice Address - Street 1:505 E MICHIGAN AVE
Practice Address - Street 2:
Practice Address - City:SALINE
Practice Address - State:MI
Practice Address - Zip Code:48176-1588
Practice Address - Country:US
Practice Address - Phone:734-944-1005
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-04-19
Last Update Date:2020-10-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5501012230225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist