Healthcare Provider Details

I. General information

NPI: 1700508207
Provider Name (Legal Business Name): KALEY BUERKEL DPT
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/13/2022
Last Update Date: 01/25/2023
Certification Date: 01/25/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

400 ROUNDS DR
FENTON MI
48430-1724
US

IV. Provider business mailing address

1311 MAMARONECK AVE STE 140
WHITE PLAINS NY
10605-5224
US

V. Phone/Fax

Practice location:
  • Phone: 810-750-1996
  • Fax: 810-750-6361
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number5501302026
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: