Basic Information
| Provider Information | |||||||||
| NPI: | 1942367263 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | PIFER | ||||||||
| FirstName: | KRISTI | ||||||||
| MiddleName: | N | ||||||||
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| Credential: | PT | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1106 W HIGH ST | ||||||||
| Address2: | |||||||||
| City: | MT PLEASANT | ||||||||
| State: | MI | ||||||||
| PostalCode: | 488582242 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9897792920 | ||||||||
| FaxNumber: | 9897729424 | ||||||||
| Practice Location | |||||||||
| Address1: | 1106 W HIGH ST | ||||||||
| Address2: | |||||||||
| City: | MT PLEASANT | ||||||||
| State: | MI | ||||||||
| PostalCode: | 488582242 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9897792920 | ||||||||
| FaxNumber: | 9897729424 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 01/03/2007 | ||||||||
| LastUpdateDate: | 06/15/2010 | ||||||||
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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 | 5501009552 | MI | Y | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Physical Therapist |
ID Information
| ID | Type | State | Issuer | Description | 352191234 | 01 | MI | PPOM PROVIDER NUMBER | OTHER | 650C710780 | 01 | MI | BCBS OF MICHIGAN | OTHER |