MEDICARE: KRISTEN LOUISE MAIKE PT WCS

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	5501009071	MI

General Provider Information

NPI Number	:	1699275495
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KRISTEN LOUISE MAIKE PT WCS

Provider Business Mailing Address
First Line	:	8701 W GRAND RIVER AVE
Second Line	:
City	:	BRIGHTON
State	:	MI
Zip	:	48116-2904
Country	:	US
Telephone Number	:	810-844-7544
Fax Number	:

Provider Business Practice Location Address
First Line	:	8701 W GRAND RIVER AVE
Second Line	:
City	:	BRIGHTON
State	:	MI
Zip	:	48116-2904
Country	:	US
Telephone Number	:	810-844-7544
Fax Number	:

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

Provider Enumeration Date	:	02/19/2018
Last Update Date	:	03/06/2026

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