Provider Demographics
NPI:1871730556
Name:MERRITT, KAREN ELIZABETH (DPT, OCS)
Entity type:Individual
Prefix:
First Name:KAREN
Middle Name:ELIZABETH
Last Name:MERRITT
Suffix:
Gender:F
Credentials:DPT, OCS
Other - Prefix:
Other - First Name:KAREN
Other - Middle Name:E
Other - Last Name:KELLY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DPT, OCS
Mailing Address - Street 1:44651 VILLAGE CT STE 120
Mailing Address - Street 2:
Mailing Address - City:PALM DESERT
Mailing Address - State:CA
Mailing Address - Zip Code:92260-3823
Mailing Address - Country:US
Mailing Address - Phone:760-501-6655
Mailing Address - Fax:760-262-3773
Practice Address - Street 1:44651 VILLAGE CT STE 120
Practice Address - Street 2:
Practice Address - City:PALM DESERT
Practice Address - State:CA
Practice Address - Zip Code:92260-3823
Practice Address - Country:US
Practice Address - Phone:760-501-6655
Practice Address - Fax:760-262-3773
Is Sole Proprietor?:No
Enumeration Date:2009-01-16
Last Update Date:2023-12-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA004346225100000X
IL070-017110225100000X
ALPTH5857225100000X
TX1194160225100000X
CA395452251X0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2251X0800XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistOrthopedic
No225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX1194160OtherTEXAS PHYSICAL THERAPY LICENSE
IL070-017110OtherILLINOIS PT LICENSE NUMBER
IA004346OtherIOWA PHYSICAL THERAPY LICENSE
CA39545OtherCA LICENSE
ALPTH5857OtherALABAMA PHYSICAL THERAPY LICENSE
IL070-017110OtherILLINOIS PT LICENSE NUMBER
ALPTH5857OtherALABAMA PHYSICAL THERAPY LICENSE