Healthcare Provider Details

I. General information

NPI: 1124268404
Provider Name (Legal Business Name): RICHARD ALLEN KLEMMER P.T.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/26/2009
Last Update Date: 12/14/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9173 STRATFORD WOODS TRL
KALAMAZOO MI
49009-4411
US

IV. Provider business mailing address

9173 STRATFORD WOODS TRL
KALAMAZOO MI
49009-4411
US

V. Phone/Fax

Practice location:
  • Phone: 269-903-5836
  • Fax:
Mailing address:
  • Phone: 269-903-5836
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2251G0304X
TaxonomyGeriatric Physical Therapist
License Number5501010462
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: