Healthcare Provider Details

I. General information

NPI: 1215325519
Provider Name (Legal Business Name): CARI FERN MCCOLLUM PHYSICAL THERAPIST
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: CARI FERN CLARK PHYSICAL THERAPIST

II. Dates (important events)

Enumeration Date: 01/08/2015
Last Update Date: 07/21/2022
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3256 WASHTENAW AVE
ANN ARBOR MI
48104-4250
US

IV. Provider business mailing address

3256 WASHTENAW AVE
ANN ARBOR MI
48104-4250
US

V. Phone/Fax

Practice location:
  • Phone: 734-975-9100
  • Fax: 734-975-9101
Mailing address:
  • Phone: 734-975-9100
  • Fax: 734-975-9101

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number1245607
License Number StateTX
# 2
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number5501018318
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: