Provider Demographics
NPI:1881644383
Name:MATHIEU, KAYLENE RENEE (PT)
Entity Type:Individual
Prefix:MRS
First Name:KAYLENE
Middle Name:RENEE
Last Name:MATHIEU
Suffix:
Gender:F
Credentials:PT
Other - Prefix:MS
Other - First Name:KAYLENE
Other - Middle Name:RENEE
Other - Last Name:SLEIK
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PT
Mailing Address - Street 1:104 DALMAR DR
Mailing Address - Street 2:
Mailing Address - City:KINGSFORD
Mailing Address - State:MI
Mailing Address - Zip Code:49802-6620
Mailing Address - Country:US
Mailing Address - Phone:906-779-5010
Mailing Address - Fax:906-563-8942
Practice Address - Street 1:104 DALMAR DR
Practice Address - Street 2:
Practice Address - City:KINGSFORD
Practice Address - State:MI
Practice Address - Zip Code:49802-6620
Practice Address - Country:US
Practice Address - Phone:906-779-5010
Practice Address - Fax:906-563-8942
Is Sole Proprietor?:No
Enumeration Date:2006-05-12
Last Update Date:2007-10-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI2303208100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & Rehabilitation
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI670B210470OtherBCBS
MI000081386Medicare PIN