Provider Demographics
NPI:1699228163
Name:RUTHER, KELLY KAY (PT, DPT)
Entity type:Individual
Prefix:
First Name:KELLY
Middle Name:KAY
Last Name:RUTHER
Suffix:
Gender:
Credentials:PT, DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2968 BROOKWIND DR
Mailing Address - Street 2:
Mailing Address - City:HOLLAND
Mailing Address - State:MI
Mailing Address - Zip Code:49424-1683
Mailing Address - Country:US
Mailing Address - Phone:616-834-1401
Mailing Address - Fax:
Practice Address - Street 1:36 W 8TH ST STE 202
Practice Address - Street 2:
Practice Address - City:HOLLAND
Practice Address - State:MI
Practice Address - Zip Code:49423-2702
Practice Address - Country:US
Practice Address - Phone:616-537-6613
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-08-01
Last Update Date:2025-02-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5501017790225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist