Provider Demographics
NPI:1174643613
Name:WALLIS, KAREN ANN (PHYSICAL THERAPIST)
Entity Type:Individual
Prefix:MS
First Name:KAREN
Middle Name:ANN
Last Name:WALLIS
Suffix:
Gender:F
Credentials:PHYSICAL THERAPIST
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:430 3RD ST
Mailing Address - Street 2:
Mailing Address - City:ANN ARBOR
Mailing Address - State:MI
Mailing Address - Zip Code:48103-4902
Mailing Address - Country:US
Mailing Address - Phone:734-665-0486
Mailing Address - Fax:
Practice Address - Street 1:2665 SHEFMAN TER
Practice Address - Street 2:
Practice Address - City:ANN ARBOR
Practice Address - State:MI
Practice Address - Zip Code:48105-3441
Practice Address - Country:US
Practice Address - Phone:734-973-6473
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-03-29
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MIMI001945225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist