Healthcare Provider Details

I. General information

NPI: 1457419913
Provider Name (Legal Business Name): KAREN LYNN COLON P.T.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/05/2006
Last Update Date: 03/10/2021
Certification Date: 03/10/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3200 BIDDLE ST 3RD FLOOR
WYANDOTTE MI
48192-5937
US

IV. Provider business mailing address

2333 BIDDLE AVE
WYANDOTTE MI
48192-4668
US

V. Phone/Fax

Practice location:
  • Phone: 734-324-3981
  • Fax: 734-284-4696
Mailing address:
  • Phone: 734-246-7732
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number5501003807
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: