Healthcare Provider Details

I. General information

NPI: 1871549857
Provider Name (Legal Business Name): KINGSLEY PHYSICAL THERAPY, P.L.L.C.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/25/2006
Last Update Date: 12/10/2025
Certification Date: 12/10/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

409 W MAIN ST
KINGSLEY MI
49649-9481
US

IV. Provider business mailing address

409 W MAIN ST
KINGSLEY MI
49649-9481
US

V. Phone/Fax

Practice location:
  • Phone: 231-263-1001
  • Fax: 231-263-1002
Mailing address:
  • Phone: 231-263-1001
  • Fax: 231-263-1002

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QP2000X
TaxonomyPhysical Therapy Clinic/Center
License Number5501010646
License Number StateMI

VIII. Authorized Official

Name: LARS MITCHELL
Title or Position: OWNER/PHYSICAL THERAPIST
Credential: MPT, OCS, CSCS
Phone: 231-263-1001