Provider Demographics
NPI:1154517217
Name:SCAFIDI, KATHLEEN
Entity type:Individual
Prefix:
First Name:KATHLEEN
Middle Name:
Last Name:SCAFIDI
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:29100 GATEWAY BLVD
Mailing Address - Street 2:SUITE 400
Mailing Address - City:FLAT ROCK
Mailing Address - State:MI
Mailing Address - Zip Code:48134
Mailing Address - Country:US
Mailing Address - Phone:734-379-7900
Mailing Address - Fax:734-379-9150
Practice Address - Street 1:29100 GATEWAY BLVD
Practice Address - Street 2:SUITE 400
Practice Address - City:FLAT ROCK
Practice Address - State:MI
Practice Address - Zip Code:48134
Practice Address - Country:US
Practice Address - Phone:734-379-7900
Practice Address - Fax:734-379-9150
Is Sole Proprietor?:No
Enumeration Date:2007-09-21
Last Update Date:2007-09-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI236836Medicare PIN