Provider Demographics
NPI:1205916673
Name:KLEIMAN, SHIRLEY ANN (DPT ICS MDT)
Entity type:Individual
Prefix:MRS
First Name:SHIRLEY
Middle Name:ANN
Last Name:KLEIMAN
Suffix:
Gender:F
Credentials:DPT ICS MDT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2816 EAST BELTLINE LANE NE
Mailing Address - Street 2:
Mailing Address - City:GRAND RAPIDS
Mailing Address - State:MI
Mailing Address - Zip Code:49525-9432
Mailing Address - Country:US
Mailing Address - Phone:616-361-1210
Mailing Address - Fax:616-361-8662
Practice Address - Street 1:2816 EAST BELTLINE LANE NE
Practice Address - Street 2:
Practice Address - City:GRAND RAPIDS
Practice Address - State:MI
Practice Address - Zip Code:49525-9432
Practice Address - Country:US
Practice Address - Phone:616-361-1210
Practice Address - Fax:616-361-8662
Is Sole Proprietor?:No
Enumeration Date:2006-10-17
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5501300694225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MION23120002Medicare ID - Type Unspecified