| Doctor Name: | NATHAN KENISTON |
| NPI Number: | 1013385806 |
| Entity Type Code: | Individual (1) |
| Gender: | M |
| Credentials: | |
| License Number: | 5501017367 |
| Business Practice Address: | 607 Dewey Ave Nw Suite 300 Grand Rapids, MI - 495047335 |
| Business Phone Number: | 6163565000 |
| Business Fax Number: | 6163565001 |
| Mailing Address: | 150 Jefferson Ave Se, Suite 100 GRAND RAPIDS |
| State: | MI |
| Postal Code: | 495034306 |
| Phone Number: | 6162843690 |
| Fax Number: | 6163011320 |
| NPI Enumeration Date: | 09/10/2015 |
| NPI Last Update Date: | 09/10/2015 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 225100000X |
| License Number: | 5501017367 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | MI |
| Taxonomy Type: | Respiratory, Developmental, Rehabilitative and Restorative Service Providers |
| Taxonomy Classification: | Physical Therapist |
| Taxonomy Specialization: | |
| Taxonomy Definition: | (1) Physical therapists are health care professionals who evaluate and treat people with health problems resulting from injury or disease. PT |