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General NPI Number Information
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NPI Number | 1376312686
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Entity Type | Individual
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Provider Name | KAELA RAE FRAILING PT, DPT
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Gender | Female
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Dates
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Enumeration Date | 12/28/2023
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Last Update Date | 12/26/2024
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Provider Practice Location Address
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Address Line | 1908 W MILHAM AVE
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City | PORTAGE
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State | MI
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Zip | 49024-1232
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Country | US
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Telephone | 269-459-6212
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Fax |
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Provider Business Mailing Address
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Address Line | 1142 VERLEEN ST
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City | KALAMAZOO
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State | MI
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Zip | 49048-9241
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Country | US
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Telephone | 269-365-6183
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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 | 5501303028
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License Number State | MI
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