Individual
ASHLEY KOOISTRA
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
DPT
Contact information
Practice address
945 E SHERMAN BLVD, NORTON SHORES, MI 49444-1805
(231) 737-4374
(231) 830-9196
Mailing address
1377 MOTOR PKWY STE 307, ISLANDIA, NY 11749-5258
(631) 580-5200
(631) 824-9335
Taxonomy
Speciality
Code
Description
License number
State
225100000X
Physical Therapist
Primary
5501019649
MI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
5501019649
STATE LICENSE
MI
Enumeration date
09/08/2020
Last updated
09/08/2020
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