Provider Demographics
NPI:1669611273
Name:KITS, JOEL KENNETH (PT)
Entity type:Individual
Prefix:
First Name:JOEL
Middle Name:KENNETH
Last Name:KITS
Suffix:
Gender:M
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:936 JOSLIN ST SE
Mailing Address - Street 2:
Mailing Address - City:GRAND RAPIDS
Mailing Address - State:MI
Mailing Address - Zip Code:49507-3310
Mailing Address - Country:US
Mailing Address - Phone:616-481-3398
Mailing Address - Fax:
Practice Address - Street 1:2120 43RD ST SE STE 100
Practice Address - Street 2:
Practice Address - City:GRAND RAPIDS
Practice Address - State:MI
Practice Address - Zip Code:49508-3712
Practice Address - Country:US
Practice Address - Phone:616-281-1144
Practice Address - Fax:616-281-1221
Is Sole Proprietor?:No
Enumeration Date:2009-02-05
Last Update Date:2009-02-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5501014208225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI0N41100Medicare UPIN