Healthcare Provider Details

I. General information

NPI: 1831905645
Provider Name (Legal Business Name): CARLEY KAIKKONEN DPT
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/06/2024
Last Update Date: 12/06/2024
Certification Date: 12/06/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1100 COOPER AVE
SAGINAW MI
48602-5354
US

IV. Provider business mailing address

1100 COOPER AVE
SAGINAW MI
48602-5354
US

V. Phone/Fax

Practice location:
  • Phone: 989-583-6395
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2251N0400X
TaxonomyNeurology Physical Therapist
License Number5501019507
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: