MEDICARE: KATHLEEN TULGESTKE P.T.

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	5501003474	MI

General Provider Information

NPI Number	:	1760520704
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KATHLEEN TULGESTKE P.T.

Provider Business Mailing Address
First Line	:	9873 S WARD BRANCH RD
Second Line	:
City	:	HAWKS
State	:	MI
Zip	:	49743-9742
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	201 S BRADLEY HWY
Second Line	:	SUITE 6
City	:	ROGERS CITY
State	:	MI
Zip	:	49779-2139
Country	:	US
Telephone Number	:	989-734-4254
Fax Number	:	989-734-8914

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

Provider Enumeration Date	:	02/02/2007
Last Update Date	:	07/08/2007

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