Provider Demographics
NPI:1881029890
Name:PAINTER, KATIE ELIZABETH (DPT)
Entity Type:Individual
Prefix:
First Name:KATIE
Middle Name:ELIZABETH
Last Name:PAINTER
Suffix:
Gender:F
Credentials:DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:37699 6 MILE RD STE 200
Mailing Address - Street 2:
Mailing Address - City:LIVONIA
Mailing Address - State:MI
Mailing Address - Zip Code:48152-3994
Mailing Address - Country:US
Mailing Address - Phone:734-425-8290
Mailing Address - Fax:734-953-1622
Practice Address - Street 1:637 N MAIN ST STE 100
Practice Address - Street 2:
Practice Address - City:ROCHESTER
Practice Address - State:MI
Practice Address - Zip Code:48307-1488
Practice Address - Country:US
Practice Address - Phone:248-608-4341
Practice Address - Fax:248-608-4368
Is Sole Proprietor?:No
Enumeration Date:2013-09-10
Last Update Date:2022-05-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5501016477225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MIMI6211090Medicare PIN
MI236614Medicare PIN