Provider Demographics
NPI:1386929255
Name:THOMAS, KATHERINE MARIE (DPT)
Entity type:Individual
Prefix:MRS
First Name:KATHERINE
Middle Name:MARIE
Last Name:THOMAS
Suffix:
Gender:F
Credentials:DPT
Other - Prefix:MISS
Other - First Name:KATHERINE
Other - Middle Name:MARIE
Other - Last Name:BOTTING
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DPT
Mailing Address - Street 1:PO BOX 30516
Mailing Address - Street 2:DEPT 5300
Mailing Address - City:LANSING
Mailing Address - State:MI
Mailing Address - Zip Code:48909-8016
Mailing Address - Country:US
Mailing Address - Phone:616-608-9978
Mailing Address - Fax:616-392-1726
Practice Address - Street 1:2000 BURTON ST SE
Practice Address - Street 2:SUITE 1
Practice Address - City:GRAND RAPIDS
Practice Address - State:MI
Practice Address - Zip Code:49506-4622
Practice Address - Country:US
Practice Address - Phone:616-608-8485
Practice Address - Fax:616-392-1728
Is Sole Proprietor?:No
Enumeration Date:2011-10-11
Last Update Date:2020-11-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5501015696225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MIP34500010Medicare PIN