MEDICARE: KATHY ANN GAINES P.T.

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	5501009463	MI

General Provider Information

NPI Number	:	1518184753
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KATHY ANN GAINES P.T.

Provider Business Mailing Address
First Line	:	3751 BRIAR PARKWAY
Second Line	:
City	:	ANN ARBOR
State	:	MI
Zip	:	48108-5905
Country	:	US
Telephone Number	:	734-929-2478
Fax Number	:

Provider Business Practice Location Address
First Line	:	2775 BOARDWALK ST
Second Line	:
City	:	ANN ARBOR
State	:	MI
Zip	:	48104-6713
Country	:	US
Telephone Number	:	734-994-2303
Fax Number	:

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

Provider Enumeration Date	:	04/19/2007
Last Update Date	:	08/01/2007

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