Provider Demographics
NPI:1497315840
Name:PLANCK, KIRA GABRIELLE (LAT, ATC)
Entity type:Individual
Prefix:
First Name:KIRA
Middle Name:GABRIELLE
Last Name:PLANCK
Suffix:
Gender:F
Credentials:LAT, ATC
Other - Prefix:
Other - First Name:KIRA
Other - Middle Name:
Other - Last Name:READING
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:33900 HARPER AVE STE 104
Mailing Address - Street 2:
Mailing Address - City:CLINTON TWP
Mailing Address - State:MI
Mailing Address - Zip Code:48035-4258
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:525 N MAIN ST STE 120
Practice Address - Street 2:
Practice Address - City:MILFORD
Practice Address - State:MI
Practice Address - Zip Code:48381-1592
Practice Address - Country:US
Practice Address - Phone:248-329-3700
Practice Address - Fax:248-329-3881
Is Sole Proprietor?:No
Enumeration Date:2019-06-18
Last Update Date:2025-09-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI26010021842255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI2601002184OtherATHLETIC TRAINER