Healthcare Provider Details

I. General information

NPI: 1679994404
Provider Name (Legal Business Name): KAREN CUSHWAY LPTA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/20/2013
Last Update Date: 10/05/2026
Certification Date: 10/05/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

15760 190TH AVE
BIG RAPIDS MI
49307-9096
US

IV. Provider business mailing address

15760 190TH AVE
BIG RAPIDS MI
49307-9096
US

V. Phone/Fax

Practice location:
  • Phone: 231-796-3543
  • Fax: 231-796-3300
Mailing address:
  • Phone: 231-796-3543
  • Fax: 231-796-3200

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225200000X
TaxonomyPhysical Therapy Assistant
License Number5502000513
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: