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General NPI Number Information
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NPI Number | 1235743212
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Entity Type | Individual
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Provider Name | SHANNON MARIE KAUTZ PT, DPT
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Gender | Female
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Dates
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Enumeration Date | 09/07/2020
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Last Update Date | 01/09/2023
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Provider Practice Location Address
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Address Line | 79 N HOWARD AVE STE B
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City | CROSWELL
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State | MI
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Zip | 48422-1222
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Country | US
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Telephone | 810-334-1090
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Fax |
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Provider Business Mailing Address
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Address Line | 5556 LAKE ST
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City | LEXINGTON
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State | MI
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Zip | 48450-8831
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Country | US
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Telephone | 810-712-1377
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 225100000X
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Taxonomy Name | Physical Therapist
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License Number | 5501019728
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License Number State | MI
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