Healthcare Provider Details

I. General information

NPI: 1376312686
Provider Name (Legal Business Name): KAELA RAE FRAILING PT, DPT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/28/2023
Last Update Date: 12/26/2024
Certification Date: 12/26/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1908 W MILHAM AVE
PORTAGE MI
49024-1232
US

IV. Provider business mailing address

1142 VERLEEN ST
KALAMAZOO MI
49048-9241
US

V. Phone/Fax

Practice location:
  • Phone: 269-459-6212
  • Fax:
Mailing address:
  • Phone: 269-365-6183
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number5501303028
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: