Individual
DR. KAELEE SARA BROCKWAY
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PT, DPT, GCS, CEEAA
Contact information
Practice address
1401 CEDAR ST NE, GRAND RAPIDS, MI 49503-1375
(616) 260-3871
Mailing address
1401 CEDAR ST NE, GRAND RAPIDS, MI 49503-1375
Taxonomy
Speciality
Code
Description
License number
State
2251G0304X
Geriatric Physical Therapist
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1659356061
—
MI
Enumeration date
03/01/2018
Last updated
03/01/2018
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