Provider Demographics
NPI:1174982102
Name:REESMAN, KRISTINA (DPT)
Entity type:Individual
Prefix:DR
First Name:KRISTINA
Middle Name:
Last Name:REESMAN
Suffix:
Gender:F
Credentials:DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 17
Mailing Address - Street 2:
Mailing Address - City:CLAWSON
Mailing Address - State:MI
Mailing Address - Zip Code:48017-0017
Mailing Address - Country:US
Mailing Address - Phone:586-838-6326
Mailing Address - Fax:855-930-1407
Practice Address - Street 1:1409 KENILWORTH PL
Practice Address - Street 2:
Practice Address - City:CLAWSON
Practice Address - State:MI
Practice Address - Zip Code:48017
Practice Address - Country:US
Practice Address - Phone:586-838-6326
Practice Address - Fax:855-930-1407
Is Sole Proprietor?:No
Enumeration Date:2016-02-18
Last Update Date:2019-09-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5501017593225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist