Doctor Name: | KEVIN TABACZKA |
NPI Number: | 1952527889 |
Entity Type Code: | Individual (1) |
Gender: | M |
Credentials: | PT |
License Number: | 5501010859 |
Business Practice Address: | 1806 E Parkdale Ave Ste 1 Manistee, MI - 496609364 |
Business Phone Number: | 2317235479 |
Business Fax Number: | 2317233586 |
Mailing Address: | 607 Pine St, MANISTEE |
State: | MI |
Postal Code: | 496601855 |
Phone Number: | 2317235479 |
Fax Number: | 2317233586 |
NPI Enumeration Date: | 04/18/2007 |
NPI Last Update Date: | 07/08/2007 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 225100000X |
License Number: | 5501010859 |
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 |