Healthcare Provider Details

I. General information

NPI: 1700548567
Provider Name (Legal Business Name): KRISTIN SENTZ PTA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: KRISTIN WILLIAMS

II. Dates (important events)

Enumeration Date: 10/08/2021
Last Update Date: 10/08/2021
Certification Date: 10/08/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2532 W CADILLAC DR
FARWELL MI
48622-9757
US

IV. Provider business mailing address

482 DONNET CT
CLARE MI
48617-8915
US

V. Phone/Fax

Practice location:
  • Phone: 989-588-9928
  • Fax:
Mailing address:
  • Phone: 989-418-0578
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225200000X
TaxonomyPhysical Therapy Assistant
License Number5502006514
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: