Provider Demographics
NPI:1275583031
Name:KIRSTEN, MARJALIZE (PT)
Entity type:Individual
Prefix:MISS
First Name:MARJALIZE
Middle Name:
Last Name:KIRSTEN
Suffix:
Gender:
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:PO BOX 412031
Mailing Address - Street 2:
Mailing Address - City:BOSTON
Mailing Address - State:MA
Mailing Address - Zip Code:02241-2031
Mailing Address - Country:US
Mailing Address - Phone:914-294-4050
Mailing Address - Fax:631-760-8306
Practice Address - Street 1:737 S US HIGHWAY 131
Practice Address - Street 2:
Practice Address - City:THREE RIVERS
Practice Address - State:MI
Practice Address - Zip Code:49093-8830
Practice Address - Country:US
Practice Address - Phone:269-256-5595
Practice Address - Fax:269-216-6634
Is Sole Proprietor?:No
Enumeration Date:2006-05-11
Last Update Date:2025-05-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5501006886225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist