MEDICARE: KEVIN ANDREW STUMPF DPT

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	225100000X	Physical Therapist	5501016515	MI

General Provider Information

NPI Number	:	1306270418
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KEVIN ANDREW STUMPF DPT

Provider Business Mailing Address
First Line	:	33900 HARPER AVE
Second Line	:	SUITE 104
City	:	CLINTON TOWNSHIP
State	:	MI
Zip	:	48035-4258
Country	:	US
Telephone Number	:	586-350-2644
Fax Number	:	586-541-3735

Provider Business Practice Location Address
First Line	:	5688 N TELEGRAPH RD
Second Line	:
City	:	DEARBORN HEIGHTS
State	:	MI
Zip	:	48127-3219
Country	:	US
Telephone Number	:	313-633-9586
Fax Number	:	313-633-9589

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	08/26/2013
Last Update Date	:	03/25/2024

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