Provider Demographics
NPI:1194981670
Name:FERRIS, KAREN R (DPT)
Entity type:Individual
Prefix:MRS
First Name:KAREN
Middle Name:R
Last Name:FERRIS
Suffix:
Gender:F
Credentials:DPT
Other - Prefix:MISS
Other - First Name:KAREN
Other - Middle Name:R
Other - Last Name:POPP
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:4727 N BROOKRIDGE LN
Mailing Address - Street 2:UNIT A
Mailing Address - City:APPLETON
Mailing Address - State:WI
Mailing Address - Zip Code:54913-8136
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:1516 S COMMERCIAL ST
Practice Address - Street 2:
Practice Address - City:NEENAH
Practice Address - State:WI
Practice Address - Zip Code:54956-4802
Practice Address - Country:US
Practice Address - Phone:920-720-7315
Practice Address - Fax:920-729-3350
Is Sole Proprietor?:No
Enumeration Date:2008-08-04
Last Update Date:2012-12-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL070-016548225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL202845003Medicare PIN