Provider Demographics
NPI:1790334803
Name:DOAN, KEI CZE (DPT)
Entity Type:Individual
Prefix:
First Name:KEI CZE
Middle Name:
Last Name:DOAN
Suffix:
Gender:F
Credentials:DPT
Other - Prefix:DR
Other - First Name:KEI CZE
Other - Middle Name:
Other - Last Name:PRENTIS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:33900 HARPER AVE STE 104
Mailing Address - Street 2:
Mailing Address - City:CLINTON TWP
Mailing Address - State:MI
Mailing Address - Zip Code:48035-4258
Mailing Address - Country:US
Mailing Address - Phone:586-350-2644
Mailing Address - Fax:586-541-3735
Practice Address - Street 1:20276 MIDDLEBELT RD STE 8
Practice Address - Street 2:
Practice Address - City:LIVONIA
Practice Address - State:MI
Practice Address - Zip Code:48152-2054
Practice Address - Country:US
Practice Address - Phone:734-655-9440
Practice Address - Fax:734-655-9441
Is Sole Proprietor?:No
Enumeration Date:2019-09-11
Last Update Date:2024-04-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5501019344225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist