Provider Demographics
NPI:1215325519
Name:MCCOLLUM, CARI FERN (PHYSICAL THERAPIST)
Entity type:Individual
Prefix:
First Name:CARI
Middle Name:FERN
Last Name:MCCOLLUM
Suffix:
Gender:F
Credentials:PHYSICAL THERAPIST
Other - Prefix:
Other - First Name:CARI
Other - Middle Name:FERN
Other - Last Name:CLARK
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PHYSICAL THERAPIST
Mailing Address - Street 1:3256 WASHTENAW AVE
Mailing Address - Street 2:
Mailing Address - City:ANN ARBOR
Mailing Address - State:MI
Mailing Address - Zip Code:48104-4250
Mailing Address - Country:US
Mailing Address - Phone:734-975-9100
Mailing Address - Fax:734-975-9101
Practice Address - Street 1:3256 WASHTENAW AVE
Practice Address - Street 2:
Practice Address - City:ANN ARBOR
Practice Address - State:MI
Practice Address - Zip Code:48104-4250
Practice Address - Country:US
Practice Address - Phone:734-975-9100
Practice Address - Fax:734-975-9101
Is Sole Proprietor?:No
Enumeration Date:2015-01-08
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX1245607225100000X
MI5501018318225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist