Provider Demographics
NPI:1245519602
Name:KRICK, MEHGAN (DPT)
Entity type:Individual
Prefix:
First Name:MEHGAN
Middle Name:
Last Name:KRICK
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 1:3655 EARL WEST RD
Mailing Address - Street 2:
Mailing Address - City:BROWN CITY
Mailing Address - State:MI
Mailing Address - Zip Code:48416-9684
Mailing Address - Country:US
Mailing Address - Phone:810-356-7441
Mailing Address - Fax:810-227-2440
Practice Address - Street 1:4217 MAIN ST
Practice Address - Street 2:
Practice Address - City:BROWN CITY
Practice Address - State:MI
Practice Address - Zip Code:48416
Practice Address - Country:US
Practice Address - Phone:810-356-7441
Practice Address - Fax:810-272-4407
Is Sole Proprietor?:Yes
Enumeration Date:2011-08-16
Last Update Date:2018-05-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist