Provider Demographics
NPI:1336389998
Name:MITCHELL, KAREN ELIZABETH
Entity Type:Individual
Prefix:
First Name:KAREN
Middle Name:ELIZABETH
Last Name:MITCHELL
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:KAREN
Other - Middle Name:ELIZABETH
Other - Last Name:GREGORICH
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:49650 CHERRY HILL RD
Mailing Address - Street 2:SUITE 230
Mailing Address - City:CANTON
Mailing Address - State:MI
Mailing Address - Zip Code:48187-4849
Mailing Address - Country:US
Mailing Address - Phone:734-495-3725
Mailing Address - Fax:734-495-3734
Practice Address - Street 1:49650 CHERRY HILL RD
Practice Address - Street 2:SUITE 230
Practice Address - City:CANTON
Practice Address - State:MI
Practice Address - Zip Code:48187-4849
Practice Address - Country:US
Practice Address - Phone:734-495-3725
Practice Address - Fax:734-495-3734
Is Sole Proprietor?:No
Enumeration Date:2009-02-23
Last Update Date:2011-02-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5501008455225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist