Healthcare Provider Details

I. General information

NPI: 1710488572
Provider Name (Legal Business Name): KATIE ANN MUELLER DPT
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/26/2018
Last Update Date: 02/26/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1215 E MICHIGAN AVE
LANSING MI
48912-1811
US

IV. Provider business mailing address

1315 COUNTRY LN
DEWITT MI
48820-9262
US

V. Phone/Fax

Practice location:
  • Phone: 517-364-2786
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number5501017281
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: