1386929255 NPI number — MRS. KATHERINE MARIE THOMAS DPT

Table of content: MRS. KATHERINE MARIE THOMAS DPT (NPI 1386929255)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1386929255 NPI number — MRS. KATHERINE MARIE THOMAS DPT

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
THOMAS
Provider First Name:
KATHERINE
Provider Middle Name:
MARIE
Provider Name Prefix Text:
MRS.
Provider Name Suffix Text:
Provider Credential Text:
DPT
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
BOTTING
Provider Other First Name:
KATHERINE
Provider Other Middle Name:
MARIE
Provider Other Name Prefix Text:
MISS
Provider Other Name Suffix Text:
Provider Other Credential Text:
DPT
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1386929255
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
11/18/2020
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 30516
Provider Second Line Business Mailing Address:
DEPT 5300
Provider Business Mailing Address City Name:
LANSING
Provider Business Mailing Address State Name:
MI
Provider Business Mailing Address Postal Code:
48909-8016
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
616-608-9978
Provider Business Mailing Address Fax Number:
616-392-1726

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
2000 BURTON ST SE
Provider Second Line Business Practice Location Address:
SUITE 1
Provider Business Practice Location Address City Name:
GRAND RAPIDS
Provider Business Practice Location Address State Name:
MI
Provider Business Practice Location Address Postal Code:
49506-4622
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
616-608-8485
Provider Business Practice Location Address Fax Number:
616-392-1728
Provider Enumeration Date:
10/11/2011

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 225100000X , with the licence number:  5501015696 , registered in the state of MI ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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