Basic Information
| Provider Information | |||||||||
| NPI: | 1740245232 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | RIPPLE | ||||||||
| FirstName: | KELLI | ||||||||
| MiddleName: | LEE | ||||||||
| NamePrefix: | |||||||||
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| Credential: | PT | ||||||||
| OtherOrganizationName: | |||||||||
| OtherOrganizationType: | |||||||||
| OtherLastName: | KIME | ||||||||
| OtherFirstName: | KELLI | ||||||||
| OtherMiddleName: | |||||||||
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| OtherLastNameType: | 1 | ||||||||
| Mailing Information | |||||||||
| Address1: | 505 E MICHIGAN AVE | ||||||||
| Address2: | |||||||||
| City: | SALINE | ||||||||
| State: | MI | ||||||||
| PostalCode: | 481761588 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7349759100 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | 505 E MICHIGAN AVE | ||||||||
| Address2: | |||||||||
| City: | SALINE | ||||||||
| State: | MI | ||||||||
| PostalCode: | 481761588 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7349441005 | ||||||||
| FaxNumber: | |||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 04/19/2006 | ||||||||
| LastUpdateDate: | 10/20/2020 | ||||||||
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| ProviderGenderCode: | F | ||||||||
| AuthorizedOfficialLastName: | |||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 10/20/2020 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 225100000X | 5501012230 | MI | Y | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Physical Therapist |
No ID Information.