Provider Demographics
NPI:1235507922
Name:FEUCHT, KARISSA (DPT)
Entity Type:Individual
Prefix:
First Name:KARISSA
Middle Name:
Last Name:FEUCHT
Suffix:
Gender:F
Credentials:DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:37250 FIVE MILE RD
Mailing Address - Street 2:UNIT D
Mailing Address - City:LIVONIA
Mailing Address - State:MI
Mailing Address - Zip Code:48154-1848
Mailing Address - Country:US
Mailing Address - Phone:734-462-3240
Mailing Address - Fax:734-462-3831
Practice Address - Street 1:9368 N LILLEY RD
Practice Address - Street 2:
Practice Address - City:PLYMOUTH
Practice Address - State:MI
Practice Address - Zip Code:48170-4610
Practice Address - Country:US
Practice Address - Phone:734-462-3240
Practice Address - Fax:734-462-3831
Is Sole Proprietor?:No
Enumeration Date:2015-09-11
Last Update Date:2015-09-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5501017244225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist