Healthcare Provider Details

I. General information

NPI: 1396777348
Provider Name (Legal Business Name): KATHLEEN A SLOWN PT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/07/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

555 N BRADLEY HWY SUITE C
ROGERS CITY MI
49779-1539
US

IV. Provider business mailing address

462 SAINT CLAIR AVE
ROGERS CITY MI
49779-1924
US

V. Phone/Fax

Practice location:
  • Phone: 989-734-7545
  • Fax:
Mailing address:
  • Phone: 989-734-8045
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number5501010256
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: