Healthcare Provider Details

I. General information

NPI: 1992067037
Provider Name (Legal Business Name): KEE PHYSICAL THERAPY, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/14/2012
Last Update Date: 06/14/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6620 WEISS ST SUITE B
SAGINAW MI
48603-2756
US

IV. Provider business mailing address

6620 WEISS ST SUITE B
SAGINAW MI
48603-2756
US

V. Phone/Fax

Practice location:
  • Phone: 989-401-3566
  • Fax: 989-401-3745
Mailing address:
  • Phone: 989-401-3566
  • Fax: 989-401-3745

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2251S0007X
TaxonomySports Physical Therapist
License Number5501003744
License Number StateMI
# 2
Primary TaxonomyN
Taxonomy Code2251X0800X
TaxonomyOrthopedic Physical Therapist
License Number5501003744
License Number StateMI
# 3
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number5501003744
License Number StateMI

VIII. Authorized Official

Name: PETER H. GENNRICH
Title or Position: PRESIDENT/ADMINISTRATOR
Credential: P.T.
Phone: 989-401-3566