Provider Demographics
NPI:1043408974
Name:CHARNHOLM, KARA MICHELE (MSPT)
Entity Type:Individual
Prefix:MS
First Name:KARA
Middle Name:MICHELE
Last Name:CHARNHOLM
Suffix:
Gender:F
Credentials:MSPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4800 S WHITE MOUNTAIN RD
Mailing Address - Street 2:STE. A
Mailing Address - City:SHOW LOW
Mailing Address - State:AZ
Mailing Address - Zip Code:85901-7876
Mailing Address - Country:US
Mailing Address - Phone:928-537-8766
Mailing Address - Fax:
Practice Address - Street 1:4800 SOUTH WHITE MOUNTAIN RD
Practice Address - Street 2:SUITE A
Practice Address - City:SHOW LOW
Practice Address - State:AZ
Practice Address - Zip Code:85901-7876
Practice Address - Country:US
Practice Address - Phone:928-537-8766
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-10-04
Last Update Date:2007-10-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ3410225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ64752Medicare PIN