Basic Information
Provider Information
NPI: 1245321447
EntityType: 1
ReplacementNPI:  
OrganizationName:  
LastName: FOUTY
FirstName: KAREN
MiddleName:  
NamePrefix: MRS.
NameSuffix:  
Credential: PT, DPT
OtherOrganizationName:  
OtherOrganizationType:  
OtherLastName:  
OtherFirstName:  
OtherMiddleName:  
OtherNamePrefix:  
OtherNameSuffix:  
OtherCredential:  
OtherLastNameType:  
Mailing Information
Address1: 2215 FULLER ROAD
Address2:  
City: ANN ARBOR
State: MI
PostalCode: 48105
CountryCode: US
TelephoneNumber: 7347697100
FaxNumber:  
Practice Location
Address1: 2215 FULLER ROAD
Address2:  
City: ANN ARBOR
State: MI
PostalCode: 48105
CountryCode: US
TelephoneNumber: 7347697100
FaxNumber:  
Other Information
ProviderEnumerationDate: 09/27/2006
LastUpdateDate: 07/13/2007
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode: F
AuthorizedOfficialLastName:  
AuthorizedOfficialFirstName:  
AuthorizedOfficialMiddleName:  
AuthorizedOfficialTitleorPosition:  
AuthorizedOfficialTelephone:  
IsSoleProprietor: N
IsOrganizationSubpart:  
ParentOrganizationLBN:  
AuthorizedOfficialNamePrefix:  
AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential:  
NPICertificationDate:  

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
225100000X5501012895MIY Respiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist 

No ID Information.


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