Basic Information
| Provider Information | |||||||||
| NPI: | 1336389998 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | MITCHELL | ||||||||
| FirstName: | KAREN | ||||||||
| MiddleName: | ELIZABETH | ||||||||
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| OtherOrganizationName: | |||||||||
| OtherOrganizationType: | |||||||||
| OtherLastName: | GREGORICH | ||||||||
| OtherFirstName: | KAREN | ||||||||
| OtherMiddleName: | ELIZABETH | ||||||||
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| OtherLastNameType: | 1 | ||||||||
| Mailing Information | |||||||||
| Address1: | 49650 CHERRY HILL RD | ||||||||
| Address2: | SUITE 230 | ||||||||
| City: | CANTON | ||||||||
| State: | MI | ||||||||
| PostalCode: | 481874849 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7344953725 | ||||||||
| FaxNumber: | 7344953734 | ||||||||
| Practice Location | |||||||||
| Address1: | 49650 CHERRY HILL RD | ||||||||
| Address2: | SUITE 230 | ||||||||
| City: | CANTON | ||||||||
| State: | MI | ||||||||
| PostalCode: | 481874849 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7344953725 | ||||||||
| FaxNumber: | 7344953734 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 02/23/2009 | ||||||||
| LastUpdateDate: | 02/22/2011 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 225100000X | 5501008455 | MI | Y | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Physical Therapist |
No ID Information.