Healthcare Provider Details

I. General information

NPI: 1083337729
Provider Name (Legal Business Name): PELLUMB KURTAGA PT, DPT
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/19/2022
Last Update Date: 05/11/2026
Certification Date: 05/11/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9339 MEADOWVIEW DR
DAVISON MI
48423-7808
US

IV. Provider business mailing address

9339 MEADOWVIEW DR
DAVISON MI
48423-7808
US

V. Phone/Fax

Practice location:
  • Phone: 810-287-5014
  • Fax:
Mailing address:
  • Phone: 810-287-5014
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number5501302019
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: