MEDICARE: MRS. KATHLEEN A SLOWN PT

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	5501010256	MI

General Provider Information

NPI Number	:	1396777348
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. KATHLEEN A SLOWN PT

Provider Business Mailing Address
First Line	:	462 SAINT CLAIR AVE
Second Line	:
City	:	ROGERS CITY
State	:	MI
Zip	:	49779-1924
Country	:	US
Telephone Number	:	989-734-8045
Fax Number	:

Provider Business Practice Location Address
First Line	:	555 N BRADLEY HWY
Second Line	:	SUITE C
City	:	ROGERS CITY
State	:	MI
Zip	:	49779-1539
Country	:	US
Telephone Number	:	989-734-7545
Fax Number	:

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

Provider Enumeration Date	:	07/07/2006
Last Update Date	:	07/08/2007

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