MEDICARE: MS. CHERYL KENNEDY-REUL PT

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	225100000X	Physical Therapist	5501014371	MI

General Provider Information

NPI Number	:	1023250008
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. CHERYL KENNEDY-REUL PT

Provider Business Mailing Address
First Line	:	261 LAKE HTS
Second Line	:
City	:	GRASS LAKE
State	:	MI
Zip	:	49240-8904
Country	:	US
Telephone Number	:	517-234-3430
Fax Number	:

Provider Business Practice Location Address
First Line	:	11755 E MICHIGAN AVE
Second Line	:
City	:	GRASS LAKE
State	:	MI
Zip	:	49240-9219
Country	:	US
Telephone Number	:	517-234-3430
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	04/06/2009
Last Update Date	:	07/31/2024

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