Provider Demographics
NPI:1306805718
Name:SORBO-GANGOLA, KAREN LORRAINE (PT)
Entity type:Individual
Prefix:MRS
First Name:KAREN
Middle Name:LORRAINE
Last Name:SORBO-GANGOLA
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:141 HAMPTON CIR
Mailing Address - Street 2:
Mailing Address - City:ROCHESTER HILLS
Mailing Address - State:MI
Mailing Address - Zip Code:48307-4103
Mailing Address - Country:US
Mailing Address - Phone:248-853-7555
Mailing Address - Fax:
Practice Address - Street 1:141 HAMPTON CIR
Practice Address - Street 2:
Practice Address - City:ROCHESTER HILLS
Practice Address - State:MI
Practice Address - Zip Code:48307-4103
Practice Address - Country:US
Practice Address - Phone:248-853-7555
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-03-23
Last Update Date:2020-12-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5501004317225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MIP44130002Medicare PIN