Individual
KEVIN JOHN MANSFIELD
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Contact information
Practice address
630 KENMOOR AVE SE STE 200, GRAND RAPIDS, MI 49546-8626
(800) 379-1600
Mailing address
7586 RANSOM ST, ZEELAND, MI 49464-9506
(616) 886-2218
Taxonomy
Speciality
Code
Description
License number
State
225200000X
Physical Therapy Assistant
Primary
5502001704
MI
Other
Enumeration date
11/25/2018
Last updated
11/25/2018
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