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General NPI Number Information
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NPI Number | 1942175666
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Entity Type | Individual
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Provider Name | KELLY M PEREGRINE PT, DPT
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Gender | Female
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Dates
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Enumeration Date | 10/10/2025
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Last Update Date | 10/17/2025
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Provider Practice Location Address
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Address Line | 5722 METRO WAY SW
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City | WYOMING
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State | MI
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Zip | 49519-9524
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Country | US
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Telephone | 616-840-7529
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Fax | 616-840-9693
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Provider Business Mailing Address
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Address Line | 235 WEALTHY ST SE
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City | GRAND RAPIDS
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State | MI
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Zip | 49503-5247
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Country | US
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Telephone | 616-840-8000
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Fax | 616-840-9690
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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 | 5501304137
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License Number State | MI
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