Provider Demographics
NPI:1881794709
Name:MUNGER, KAREN M (PT)
Entity type:Individual
Prefix:
First Name:KAREN
Middle Name:M
Last Name:MUNGER
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:847 PARCHMENT DR SE STE 101
Mailing Address - Street 2:
Mailing Address - City:GRAND RAPIDS
Mailing Address - State:MI
Mailing Address - Zip Code:49546-2303
Mailing Address - Country:US
Mailing Address - Phone:616-516-4334
Mailing Address - Fax:616-333-5311
Practice Address - Street 1:8450 ALGOMA AVE NE
Practice Address - Street 2:SUITE AAA
Practice Address - City:ROCKFORD
Practice Address - State:MI
Practice Address - Zip Code:49341-7507
Practice Address - Country:US
Practice Address - Phone:616-863-9731
Practice Address - Fax:616-863-9831
Is Sole Proprietor?:No
Enumeration Date:2006-09-22
Last Update Date:2024-12-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5501010479225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MIKM010479Medicare UPIN
MIN95540011Medicare ID - Type Unspecified