Provider Demographics
NPI:1811203284
Name:GLASHAUSER, KARLEY AUTUMN (PT, DPT, CBIS)
Entity Type:Individual
Prefix:DR
First Name:KARLEY
Middle Name:AUTUMN
Last Name:GLASHAUSER
Suffix:
Gender:F
Credentials:PT, DPT, CBIS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:208 ROMAIN RD
Mailing Address - Street 2:APT 203
Mailing Address - City:CARO
Mailing Address - State:MI
Mailing Address - Zip Code:48723-9127
Mailing Address - Country:US
Mailing Address - Phone:586-557-0363
Mailing Address - Fax:
Practice Address - Street 1:1655 E CARO RD
Practice Address - Street 2:
Practice Address - City:CARO
Practice Address - State:MI
Practice Address - Zip Code:48723-9319
Practice Address - Country:US
Practice Address - Phone:989-673-2500
Practice Address - Fax:383-673-3979
Is Sole Proprietor?:Yes
Enumeration Date:2010-08-24
Last Update Date:2020-11-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5501014566225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist