Healthcare Provider Details

I. General information

NPI: 1942885066
Provider Name (Legal Business Name): AMY LYNN KIPFMUELLER
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/10/2021
Last Update Date: 03/10/2021
Certification Date: 03/10/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4040 BEACON ST
KINGSLEY MI
49649-9548
US

IV. Provider business mailing address

379 SIERRA DR
TRAVERSE CITY MI
49685-9182
US

V. Phone/Fax

Practice location:
  • Phone: 231-263-1353
  • Fax:
Mailing address:
  • Phone: 231-709-3988
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225200000X
TaxonomyPhysical Therapy Assistant
License Number5502002539
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: