Individual
KALA M FREDERIKSEN
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PT
Contact information
Practice address
42369 CRESTVIEW CIR, NORTHVILLE, MI 48168-3266
(515) 231-7057
Mailing address
42369 CRESTVIEW CIR, NORTHVILLE, MI 48168-3266
(515) 231-7057
Taxonomy
Speciality
Code
Description
License number
State
225100000X
Physical Therapist
Primary
077175
IA
225100000X
Physical Therapist
11819-24
WI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1053606657
—
WI
Enumeration date
06/13/2011
Last updated
04/15/2025
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