Michelle Koetje, PT, DPT

Primary specialty

Physical TherapistTaxonomy code 225100000X

License

5501302979 Issued in MI

Practice address

18000 Cove St Ste 202
Spring Lake, MI 49456-1383

Phone

(616) 847-1280

Fax

(616) 847-1290

NPI assigned

Aug 23, 2023

Sex

Female

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Enrolled in MI

Enrollment records 1

Specialty

Physical Therapist in Private Practice

Education

Other, 2023

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

Shoreline Sport and Spine PLLCGroup PAC ID 4284673575, 44 clinicians

Practice addresses (Care Compare)

Medicare enrollment (NPD)

Enrolled

State licenses

Practice roles

Locations

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

• Shoreline Sport & Spine PLLC

  • Physical Therapist
  • Spring Lake, MI
  • NPI 1225040694
  Medicare reassignment Care Compare group NPD
• Shoreline Sport & Spine PLLC

  • Physical Therapist
  • Muskegon, MI
  • NPI 1619787959
  NPD

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1692748800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1692748800000",
    "number": "1104600766",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "18000 COVE ST STE 202",
            "city": "SPRING LAKE",
            "state": "MI",
            "postal_code": "494561383",
            "telephone_number": "616-847-1280",
            "fax_number": "616-847-1290"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "18000 COVE ST STE 202",
            "city": "SPRING LAKE",
            "state": "MI",
            "postal_code": "494561383",
            "telephone_number": "616-847-1280",
            "fax_number": "616-847-1290"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "KOETJE",
        "first_name": "MICHELLE",
        "credential": "PT, DPT",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2023-08-23",
        "last_updated": "2023-08-23",
        "certification_date": "2023-08-23",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "225100000X",
            "taxonomy_group": "",
            "desc": "Physical Therapist",
            "state": "MI",
            "license": "5501302979",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Kayla Ann King, OTR/L
• John Robert Kleinheksel Jr., M. DIV. L.M.S.W.
• Amy Kristine Klintworth
• Nicole Renee Koch
• Kristine A Koetje, MA LPC LLP
• Kowalski Counseling
• Kylee M Kowalski, DLLP
• Kristine Koetje Ma, PC
• Kristine Koetje Ma, PC
• Kristine Koetje, Ma LP

• Physical Therapist in Spring Lake, MI
• Providers in Spring Lake, MI by specialty
• Physical Therapist in Michigan

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 23, 2023; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.