Healthcare Provider Details

I. General information

NPI: 1598241481
Provider Name (Legal Business Name): BRADLEY JAMES KUIPERS PT
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/14/2018
Last Update Date: 05/29/2025
Certification Date: 05/29/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

890 WASHINGTON AVE STE 130-A
HOLLAND MI
49423
US

IV. Provider business mailing address

18000 COVE STREET SUITE 202
SPRING LAKE MI
49456-1383
US

V. Phone/Fax

Practice location:
  • Phone: 616-994-8136
  • Fax: 616-994-8162
Mailing address:
  • Phone: 616-847-1280
  • Fax: 616-847-1290

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number5501009663
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: