=====================================================
General NPI Number Information
=====================================================
NPI Number | 1881029890
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | KATIE ELIZABETH PAINTER DPT
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 09/10/2013
-----------------------------------------------------
Last Update Date | 05/10/2022
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 637 N MAIN ST STE 100
-----------------------------------------------------
City | ROCHESTER
-----------------------------------------------------
State | MI
-----------------------------------------------------
Zip | 48307-1488
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 248-608-4341
-----------------------------------------------------
Fax | 248-608-4368
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 37699 6 MILE RD STE 200
-----------------------------------------------------
City | LIVONIA
-----------------------------------------------------
State | MI
-----------------------------------------------------
Zip | 48152-3994
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 734-425-8290
-----------------------------------------------------
Fax | 734-953-1622
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 225100000X
-----------------------------------------------------
Taxonomy Name | Physical Therapist
-----------------------------------------------------
License Number | 5501016477
-----------------------------------------------------
License Number State | MI
-----------------------------------------------------