Provider Demographics
NPI:1699276105
Name:WATROBA, KIM (PT, CLT)
Entity type:Individual
Prefix:
First Name:KIM
Middle Name:
Last Name:WATROBA
Suffix:
Gender:F
Credentials:PT, CLT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:26850 PROVIDENCE PKWY STE 163
Mailing Address - Street 2:
Mailing Address - City:NOVI
Mailing Address - State:MI
Mailing Address - Zip Code:48374-1254
Mailing Address - Country:US
Mailing Address - Phone:248-465-4190
Mailing Address - Fax:
Practice Address - Street 1:26850 PROVIDENCE PKWY STE 163
Practice Address - Street 2:
Practice Address - City:NOVI
Practice Address - State:MI
Practice Address - Zip Code:48374-1254
Practice Address - Country:US
Practice Address - Phone:248-465-4190
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-02-21
Last Update Date:2018-02-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist