Healthcare Provider Details

I. General information

NPI: 1780808436
Provider Name (Legal Business Name): KAREN E SMITH P.T.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/12/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2300 WATKINS LAKE RD
WATERFORD MI
48328-1439
US

IV. Provider business mailing address

2346 LONDON BRIDGE DR UNIT 63
ROCHESTER HILLS MI
48307-4267
US

V. Phone/Fax

Practice location:
  • Phone: 248-853-1629
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2251G0304X
TaxonomyGeriatric Physical Therapist
License Number5501011173
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: