Healthcare Provider Details

I. General information

NPI: 1407444862
Provider Name (Legal Business Name): KELLY CIPRIANO PT, DPT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/31/2020
Last Update Date: 03/07/2023
Certification Date: 03/07/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1665 HAMILTON RD STE 100
OKEMOS MI
48864-1809
US

IV. Provider business mailing address

1690 GONE AWAY LN
WHEATON IL
60189-7229
US

V. Phone/Fax

Practice location:
  • Phone: 517-349-1110
  • Fax:
Mailing address:
  • Phone: 630-621-7988
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number070025666
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: