Provider Demographics
NPI:1689673345
Name:BOREN, KAREN LEHMAN (PT,)
Entity Type:Individual
Prefix:MRS
First Name:KAREN
Middle Name:LEHMAN
Last Name:BOREN
Suffix:
Gender:F
Credentials:PT,
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4768 WALNUT CREEK CIR
Mailing Address - Street 2:
Mailing Address - City:WEST BLOOMFIELD
Mailing Address - State:MI
Mailing Address - Zip Code:48322-3493
Mailing Address - Country:US
Mailing Address - Phone:248-932-5393
Mailing Address - Fax:248-932-5392
Practice Address - Street 1:4768 WALNUT CREEK CIR
Practice Address - Street 2:
Practice Address - City:WEST BLOOMFIELD
Practice Address - State:MI
Practice Address - Zip Code:48322-3493
Practice Address - Country:US
Practice Address - Phone:248-932-5393
Practice Address - Fax:248-932-5392
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-07-15
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5501001768225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI5501001768OtherMI P.T. LICENSE #
MI0M76870Medicare ID - Type UnspecifiedMEDICARE PROVIDER #