Healthcare Provider Details

I. General information

NPI: 1891057071
Provider Name (Legal Business Name): KRISTIN L HOSMER DPT
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: KRISTIN COBB

II. Dates (important events)

Enumeration Date: 06/13/2012
Last Update Date: 07/20/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1335 W MAIN ST STE B
LOWELL MI
49331-1555
US

IV. Provider business mailing address

4761 LAKE MICHIGAN DR NW STE A
GRAND RAPIDS MI
49534-6300
US

V. Phone/Fax

Practice location:
  • Phone: 616-888-3184
  • Fax: 616-888-3190
Mailing address:
  • Phone: 616-608-9978
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number5501015432
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: