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NPI Code Detail

MEDICARE: KELSEY MARIE MCNUTT

MEDICARE: KELSEY MARIE MCNUTT
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
1225100000XPhysical TherapistMI

General Provider Information

NPI Number : 1528415726
Entity Type Code : Individual
Provider Name (Legal Business Name) : KELSEY MARIE MCNUTT
Provider Business Mailing Address
First Line : 790 REMINGTON BLVD
Second Line :
City : BOLINGBROOK
State : IL
Zip : 60440-4909
Country : US
Telephone Number : 248-683-0185
Fax Number : 248-683-5692
Provider Business Practice Location Address
First Line : 2700 ORCHARD LAKE RD
Second Line :
City : KEEGO HARBOR
State : MI
Zip : 48320-1445
Country : US
Telephone Number : 248-683-0185
Fax Number : 248-683-5692
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 05/17/2016
Last Update Date : 09/19/2023

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Directions to “ KELSEY MARIE MCNUTT ” Practice Location

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