Basic Information
| Provider Information | |||||||||
| NPI: | 1730603325 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | ALLORE | ||||||||
| FirstName: | KAITLYN | ||||||||
| MiddleName: | MARIE | ||||||||
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| Credential: | DPT | ||||||||
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| Mailing Information | |||||||||
| Address1: | 45084 DEEPWOOD CT | ||||||||
| Address2: | |||||||||
| City: | SHELBY TOWNSHIP | ||||||||
| State: | MI | ||||||||
| PostalCode: | 483174976 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9898604484 | ||||||||
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| Practice Location | |||||||||
| Address1: | 5656 W US HIGHWAY 10 | ||||||||
| Address2: | |||||||||
| City: | LUDINGTON | ||||||||
| State: | MI | ||||||||
| PostalCode: | 494312454 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2318432543 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 07/26/2017 | ||||||||
| LastUpdateDate: | 07/26/2017 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 225100000X | 5501017812 | MI | Y | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Physical Therapist |
ID Information
| ID | Type | State | Issuer | Description | 5501017812 | 01 | MI | PHYSICAL THERAPIST | OTHER |