Healthcare Provider Details

I. General information

NPI: 1619684636
Provider Name (Legal Business Name): SUSAN MEHOK PTA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: SUSAN CAREY

II. Dates (important events)

Enumeration Date: 10/31/2022
Last Update Date: 02/07/2025
Certification Date: 02/07/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

856 N SUPERIOR DR
CROWN POINT IN
46307-8299
US

IV. Provider business mailing address

33900 HARPER AVE STE 104
CLINTON TWP MI
48035-4258
US

V. Phone/Fax

Practice location:
  • Phone: 219-213-3942
  • Fax:
Mailing address:
  • Phone: 586-350-2644
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225200000X
TaxonomyPhysical Therapy Assistant
License Number06002711A
License Number StateIN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: