Basic Information
| Provider Information | |||||||||
| NPI: | 1962903518 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | KELCH | ||||||||
| FirstName: | AMANDA | ||||||||
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| Credential: | DPT | ||||||||
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| Mailing Information | |||||||||
| Address1: | 670 BARBER AVE | ||||||||
| Address2: | |||||||||
| City: | ANN ARBOR | ||||||||
| State: | MI | ||||||||
| PostalCode: | 481032726 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2489785650 | ||||||||
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| Practice Location | |||||||||
| Address1: | 5840 INTERFACE DR STE 400 | ||||||||
| Address2: | |||||||||
| City: | ANN ARBOR | ||||||||
| State: | MI | ||||||||
| PostalCode: | 481039176 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7346278001 | ||||||||
| FaxNumber: | 7344331989 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 02/27/2018 | ||||||||
| LastUpdateDate: | 03/24/2022 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 03/24/2022 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 225100000X | PT296010 | CA | N | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Physical Therapist | 2251N0400X | 5501018365 | MI | N | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Physical Therapist | Neurology | 225100000X | 5501018365 | MI | Y | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Physical Therapist |
No ID Information.