Healthcare Provider Details

I. General information

NPI: 1053527424
Provider Name (Legal Business Name): CAROL G PLISNER PT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/15/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

30586 CLUB HOUSE LN
FARMINGTON HILLS MI
48334-1117
US

IV. Provider business mailing address

30586 CLUB HOUSE LN
FARMINGTON HILLS MI
48334-1117
US

V. Phone/Fax

Practice location:
  • Phone: 248-851-0119
  • Fax:
Mailing address:
  • Phone: 248-851-0119
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number5501004247
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: