Healthcare Provider Details

I. General information

NPI: 1245661149
Provider Name (Legal Business Name): KELLI HEYINK PT,DPT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/03/2013
Last Update Date: 12/03/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

800 W LAWRENCE AVE
CHARLOTTE MI
48813-1308
US

IV. Provider business mailing address

11310 TOLES RD
EATON RAPIDS MI
48827-9754
US

V. Phone/Fax

Practice location:
  • Phone: 517-541-5800
  • Fax:
Mailing address:
  • Phone: 517-490-6602
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number5501015462
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: