Healthcare Provider Details

I. General information

NPI: 1669014411
Provider Name (Legal Business Name): AUSTIN KROMPETZ
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/14/2019
Last Update Date: 10/14/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1500 W HIGH ST
MOUNT PLEASANT MI
48858-3028
US

IV. Provider business mailing address

1500 W HIGH ST
MOUNT PLEASANT MI
48858-3028
US

V. Phone/Fax

Practice location:
  • Phone: 989-772-0258
  • Fax:
Mailing address:
  • Phone: 989-772-0258
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225200000X
TaxonomyPhysical Therapy Assistant
License Number5502005887
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: