Healthcare Provider Details

I. General information

NPI: 1164360004
Provider Name (Legal Business Name): LEIGHANN KAY DEVRIES
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/23/2026
Last Update Date: 03/23/2026
Certification Date: 03/23/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

400 JEFFREY ST
CEDAR SPRINGS MI
49319-9572
US

IV. Provider business mailing address

341 CLEVELAND ST W
COOPERSVILLE MI
49404-9673
US

V. Phone/Fax

Practice location:
  • Phone: 616-696-0170
  • Fax:
Mailing address:
  • Phone: 616-862-9267
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225200000X
TaxonomyPhysical Therapy Assistant
License Number5502002269
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: