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NPI Code Detail

MEDICARE: KRISTEN NICOLE ALCANTARA PTA

MEDICARE: KRISTEN NICOLE ALCANTARA PTA
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
1225200000XPhysical Therapy Assistant06004819AIN

General Provider Information

NPI Number : 1487327458
Entity Type Code : Individual
Provider Name (Legal Business Name) : KRISTEN NICOLE ALCANTARA PTA
Provider Business Mailing Address
First Line : 33900 HARPER AVE STE 104
Second Line :
City : CLINTON TWP
State : MI
Zip : 48035-4258
Country : US
Telephone Number : 586-350-2644
Fax Number :
Provider Business Practice Location Address
First Line : 223 CHICAGO AVE
Second Line :
City : GOSHEN
State : IN
Zip : 46526-2311
Country : US
Telephone Number : 574-584-3200
Fax Number : 574-584-3204
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 07/27/2021
Last Update Date : 07/27/2021

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Directions to “ KRISTEN NICOLE ALCANTARA PTA” Practice Location

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