Provider Demographics
NPI:1588988679
Name:HARVELL, CARA LYNNE (PT)
Entity type:Individual
Prefix:MS
First Name:CARA
Middle Name:LYNNE
Last Name:HARVELL
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 1:39885 GRAND RIVER AVE
Mailing Address - Street 2:
Mailing Address - City:NOVI
Mailing Address - State:MI
Mailing Address - Zip Code:48375-2151
Mailing Address - Country:US
Mailing Address - Phone:248-615-0282
Mailing Address - Fax:248-615-0415
Practice Address - Street 1:39885 GRAND RIVER AVE
Practice Address - Street 2:
Practice Address - City:NOVI
Practice Address - State:MI
Practice Address - Zip Code:48375-2151
Practice Address - Country:US
Practice Address - Phone:248-615-0282
Practice Address - Fax:248-615-0415
Is Sole Proprietor?:Yes
Enumeration Date:2010-03-18
Last Update Date:2010-03-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5501015093225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist