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General NPI Number Information
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NPI Number | 1740738970
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Entity Type | Individual
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Provider Name | ANDREA KATHERINE KOUEITER DPT
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Gender | Female
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Dates
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Enumeration Date | 09/16/2016
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Last Update Date | 03/24/2021
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Provider Practice Location Address
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Address Line | 2799 W GRAND BLVD
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City | DETROIT
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State | MI
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Zip | 48202-2608
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Country | US
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Telephone | 313-916-2600
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Fax |
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Provider Business Mailing Address
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Address Line | 1111 N OXFORD RD
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City | GROSSE POINTE WOODS
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State | MI
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Zip | 48236-1858
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Country | US
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Telephone | 313-820-6525
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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 | PT 60656501
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License Number State | WA
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