Active NPI
Kristine Den Boer, PT, DPT
- Physical Therapist
- Grand Rapids, MI
National Provider Identifier
1750957924
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Physical Therapist
- License
- 5501018770
- Practice address
- 1840 Wealthy St SE
Grand Rapids, MI 49506-2921 - Phone
- (616) 382-0520
- NPI assigned
- May 28, 2021
- Sex
- Female
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Physical Therapist | 225100000X | 5501018770 | MI | Primary |
Addresses
Primary practice location
1840 Wealthy St SE
Grand Rapids, MI 49506-2921
Mailing address
1517 Pine Ave NW
Grand Rapids, MI 49504-3028
Phone (616) 340-4693
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 5501018770 | MI | MD | Physical Therapist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1622160000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1622160000000",
"number": "1750957924",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "1517 PINE AVE NW",
"city": "GRAND RAPIDS",
"state": "MI",
"postal_code": "495043028",
"telephone_number": "616-340-4693"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1840 WEALTHY ST SE",
"city": "GRAND RAPIDS",
"state": "MI",
"postal_code": "495062921",
"telephone_number": "616-382-0520"
}
],
"practiceLocations": [],
"basic": {
"last_name": "DEN BOER",
"first_name": "KRISTINE",
"name_prefix": "Dr.",
"credential": "PT, DPT",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2021-05-28",
"last_updated": "2021-05-28",
"certification_date": "2021-05-28",
"status": "A"
},
"taxonomies": [
{
"code": "225100000X",
"taxonomy_group": "",
"desc": "Physical Therapist",
"state": "MI",
"license": "5501018770",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Grand Rapids, MI
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 28, 2021; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.