Provider Demographics
NPI:1457199457
Name:FISTLER, KARSYN (PTA)
Entity type:Individual
Prefix:
First Name:KARSYN
Middle Name:
Last Name:FISTLER
Suffix:
Gender:F
Credentials:PTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:67232 GRATIOT AVE
Mailing Address - Street 2:
Mailing Address - City:RICHMOND
Mailing Address - State:MI
Mailing Address - Zip Code:48062-1915
Mailing Address - Country:US
Mailing Address - Phone:586-430-1154
Mailing Address - Fax:586-430-1174
Practice Address - Street 1:67232 GRATIOT AVE
Practice Address - Street 2:
Practice Address - City:RICHMOND
Practice Address - State:MI
Practice Address - Zip Code:48062-1915
Practice Address - Country:US
Practice Address - Phone:586-430-1154
Practice Address - Fax:586-430-1174
Is Sole Proprietor?:No
Enumeration Date:2024-07-16
Last Update Date:2024-07-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5502008541225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant