Provider Demographics
NPI:1922734581
Name:MITTON, KAREN CROWTHER (PTA, CLT)
Entity Type:Individual
Prefix:
First Name:KAREN
Middle Name:CROWTHER
Last Name:MITTON
Suffix:
Gender:F
Credentials:PTA, CLT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1372 BICENTENNIAL PKWY
Mailing Address - Street 2:
Mailing Address - City:ANN ARBOR
Mailing Address - State:MI
Mailing Address - Zip Code:48108-7917
Mailing Address - Country:US
Mailing Address - Phone:734-945-6055
Mailing Address - Fax:
Practice Address - Street 1:20555 VICTOR PKWY
Practice Address - Street 2:
Practice Address - City:LIVONIA
Practice Address - State:MI
Practice Address - Zip Code:48152-7031
Practice Address - Country:US
Practice Address - Phone:734-343-2476
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-07-26
Last Update Date:2022-07-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5502007973225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant