Provider Demographics
NPI:1649440835
Name:FELIX-WALL, DAWN CHERI (PT)
Entity type:Individual
Prefix:MISS
First Name:DAWN
Middle Name:CHERI
Last Name:FELIX-WALL
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:29256 RYAN RD
Mailing Address - Street 2:
Mailing Address - City:WARREN
Mailing Address - State:MI
Mailing Address - Zip Code:48092-4242
Mailing Address - Country:US
Mailing Address - Phone:586-751-6667
Mailing Address - Fax:586-751-1888
Practice Address - Street 1:29256 RYAN RD
Practice Address - Street 2:
Practice Address - City:WARREN
Practice Address - State:MI
Practice Address - Zip Code:48092-4242
Practice Address - Country:US
Practice Address - Phone:586-751-6667
Practice Address - Fax:586-751-1888
Is Sole Proprietor?:No
Enumeration Date:2008-03-04
Last Update Date:2008-03-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5501004283225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist