Healthcare Provider Details

I. General information

NPI: 1164231452
Provider Name (Legal Business Name): KATIE DEWITT DPT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: KATIE KIRKUM

II. Dates (important events)

Enumeration Date: 01/02/2025
Last Update Date: 07/28/2026
Certification Date: 07/28/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

31503 HARPER AVE
SAINT CLAIR SHORES MI
48082-2455
US

IV. Provider business mailing address

22415 MANOR ST
SAINT CLAIR SHORES MI
48081-2320
US

V. Phone/Fax

Practice location:
  • Phone: 586-500-5496
  • Fax: 248-268-0186
Mailing address:
  • Phone: 586-850-0436
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number5501303685
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: