Provider Demographics
NPI:1508262106
Name:MORGAN, KAREN (PTA)
Entity Type:Individual
Prefix:
First Name:KAREN
Middle Name:
Last Name:MORGAN
Suffix:
Gender:F
Credentials:PTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:18200 E 10 MILE RD
Mailing Address - Street 2:200
Mailing Address - City:EASTPOINTE
Mailing Address - State:MI
Mailing Address - Zip Code:48021-1368
Mailing Address - Country:US
Mailing Address - Phone:586-439-2901
Mailing Address - Fax:586-439-2902
Practice Address - Street 1:18200 E 10 MILE RD
Practice Address - Street 2:200
Practice Address - City:EASTPOINTE
Practice Address - State:MI
Practice Address - Zip Code:48021-1368
Practice Address - Country:US
Practice Address - Phone:586-439-2901
Practice Address - Fax:586-439-2902
Is Sole Proprietor?:No
Enumeration Date:2014-11-08
Last Update Date:2014-11-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MI5502000657225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI5502000657OtherSTATE OF MICHIGAN