Provider Demographics
NPI:1891057071
Name:HOSMER, KRISTIN L (DPT)
Entity Type:Individual
Prefix:DR
First Name:KRISTIN
Middle Name:L
Last Name:HOSMER
Suffix:
Gender:F
Credentials:DPT
Other - Prefix:
Other - First Name:KRISTIN
Other - Middle Name:
Other - Last Name:COBB
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:4761 LAKE MICHIGAN DR NW STE A
Mailing Address - Street 2:
Mailing Address - City:GRAND RAPIDS
Mailing Address - State:MI
Mailing Address - Zip Code:49534-6300
Mailing Address - Country:US
Mailing Address - Phone:616-608-9978
Mailing Address - Fax:
Practice Address - Street 1:1335 W MAIN ST STE B
Practice Address - Street 2:
Practice Address - City:LOWELL
Practice Address - State:MI
Practice Address - Zip Code:49331-1555
Practice Address - Country:US
Practice Address - Phone:616-888-3184
Practice Address - Fax:616-888-3190
Is Sole Proprietor?:Yes
Enumeration Date:2012-06-13
Last Update Date:2018-07-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5501015432225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist