Healthcare Provider Details

I. General information

NPI: 1487254561
Provider Name (Legal Business Name): ERIC KINNEY PT, DPT
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/28/2020
Last Update Date: 10/28/2020
Certification Date: 10/28/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

46001 GRAND RIVER AVE
NOVI MI
48374-1319
US

IV. Provider business mailing address

2141 NORTON RD
HOWELL MI
48843-7900
US

V. Phone/Fax

Practice location:
  • Phone: 248-513-3003
  • Fax:
Mailing address:
  • Phone: 734-915-3125
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2251X0800X
TaxonomyOrthopedic Physical Therapist
License Number5501019794
License Number StateMI
# 2
Primary TaxonomyY
Taxonomy Code2251S0007X
TaxonomySports Physical Therapist
License Number5501019794
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: