Provider Demographics
NPI:1952647661
Name:DEBRUYN, KAREN (PT, DIPLOM)
Entity Type:Individual
Prefix:
First Name:KAREN
Middle Name:
Last Name:DEBRUYN
Suffix:
Gender:F
Credentials:PT, DIPLOM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8308 OFFICE PARK DR
Mailing Address - Street 2:SUITE #2
Mailing Address - City:GRAND BLANC
Mailing Address - State:MI
Mailing Address - Zip Code:48439-2075
Mailing Address - Country:US
Mailing Address - Phone:810-694-3500
Mailing Address - Fax:810-236-8779
Practice Address - Street 1:8308 OFFICE PARK DR
Practice Address - Street 2:SUITE #2
Practice Address - City:GRAND BLANC
Practice Address - State:MI
Practice Address - Zip Code:48439-2075
Practice Address - Country:US
Practice Address - Phone:810-694-3500
Practice Address - Fax:810-236-8779
Is Sole Proprietor?:Yes
Enumeration Date:2012-12-27
Last Update Date:2014-12-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5401000067171100000X
MI5501001365225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist
No225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist