Provider Demographics
NPI:1215149547
Name:ADAMS, KOLEEN MARIE (PT)
Entity type:Individual
Prefix:MRS
First Name:KOLEEN
Middle Name:MARIE
Last Name:ADAMS
Suffix:
Gender:F
Credentials:PT
Other - Prefix:MISS
Other - First Name:KOLEEN
Other - Middle Name:MARIE
Other - Last Name:BRADY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PT
Mailing Address - Street 1:6906 ENGLISH RD
Mailing Address - Street 2:
Mailing Address - City:SILVERWOOD
Mailing Address - State:MI
Mailing Address - Zip Code:48760-9402
Mailing Address - Country:US
Mailing Address - Phone:810-656-9862
Mailing Address - Fax:
Practice Address - Street 1:6906 ENGLISH RD
Practice Address - Street 2:
Practice Address - City:SILVERWOOD
Practice Address - State:MI
Practice Address - Zip Code:48760-9402
Practice Address - Country:US
Practice Address - Phone:810-656-9862
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-05-07
Last Update Date:2023-07-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5501012724225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist