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General NPI Number Information
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NPI Number | 1487566790
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Entity Type | Individual
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Provider Name | KRISTA BLIEVERNICHT PTA
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Gender | Female
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Dates
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Enumeration Date | 09/21/2026
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Last Update Date | 09/21/2026
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Provider Practice Location Address
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Address Line | 2815 NORTHWIND DR
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City | EAST LANSING
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State | MI
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Zip | 48823-5003
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Country | US
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Telephone | 517-483-3004
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Fax |
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Provider Business Mailing Address
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Address Line | 9800 BOND RD
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City | DEWITT
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State | MI
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Zip | 48820-8498
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Country | US
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Telephone | 517-483-3004
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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 | 225200000X
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Taxonomy Name | Physical Therapy Assistant
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License Number | 5502008628
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License Number State | MI
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