Provider Demographics
NPI:1649521030
Name:DOBBIE, KATHLEEN JUZYSTA (DPT)
Entity type:Individual
Prefix:
First Name:KATHLEEN
Middle Name:JUZYSTA
Last Name:DOBBIE
Suffix:
Gender:F
Credentials:DPT
Other - Prefix:
Other - First Name:KATHLEEN
Other - Middle Name:NICOLE
Other - Last Name:JUZYSTA
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DPT
Mailing Address - Street 1:22180 PONTIAC TRL
Mailing Address - Street 2:SUITE E
Mailing Address - City:SOUTH LYON
Mailing Address - State:MI
Mailing Address - Zip Code:48178-9097
Mailing Address - Country:US
Mailing Address - Phone:248-446-0155
Mailing Address - Fax:248-446-0177
Practice Address - Street 1:22180 PONTIAC TRL
Practice Address - Street 2:SUITE E
Practice Address - City:SOUTH LYON
Practice Address - State:MI
Practice Address - Zip Code:48178-9097
Practice Address - Country:US
Practice Address - Phone:248-446-0155
Practice Address - Fax:248-446-0177
Is Sole Proprietor?:No
Enumeration Date:2012-09-25
Last Update Date:2014-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5501016079225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist