Provider Demographics
NPI:1891325684
Name:CARL, KRISTIN N
Entity Type:Individual
Prefix:
First Name:KRISTIN
Middle Name:N
Last Name:CARL
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:13347 NADINE AVE
Mailing Address - Street 2:
Mailing Address - City:HUNTINGTON WOODS
Mailing Address - State:MI
Mailing Address - Zip Code:48070-1422
Mailing Address - Country:US
Mailing Address - Phone:586-854-1364
Mailing Address - Fax:
Practice Address - Street 1:15959 HALL RD STE 410
Practice Address - Street 2:
Practice Address - City:MACOMB
Practice Address - State:MI
Practice Address - Zip Code:48044-5365
Practice Address - Country:US
Practice Address - Phone:586-416-6290
Practice Address - Fax:586-416-6295
Is Sole Proprietor?:No
Enumeration Date:2020-01-21
Last Update Date:2020-01-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI55010194422251P0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2251P0200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistPediatrics