Healthcare Provider Details

I. General information

NPI: 1497295471
Provider Name (Legal Business Name): KRISTINE HEPNER DPT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: KRISTINE KASSL DPT

II. Dates (important events)

Enumeration Date: 02/24/2017
Last Update Date: 01/26/2021
Certification Date: 01/26/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

856 N SUPERIOR DR
CROWN POINT IN
46307
US

IV. Provider business mailing address

33900 HARPER AVE STE 104
CLINTON TWP MI
48035-4258
US

V. Phone/Fax

Practice location:
  • Phone: 219-213-3942
  • Fax: 219-213-3943
Mailing address:
  • Phone: 586-350-2644
  • Fax: 586-350-2644

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number070023106
License Number StateIL
# 2
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number05013235A
License Number StateIN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: