Provider Demographics
NPI:1073719324
Name:PAUL, CAROL ANN (PT)
Entity Type:Individual
Prefix:
First Name:CAROL
Middle Name:ANN
Last Name:PAUL
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:PO BOX 2396
Mailing Address - Street 2:
Mailing Address - City:CAMARILLO
Mailing Address - State:CA
Mailing Address - Zip Code:93011-2396
Mailing Address - Country:US
Mailing Address - Phone:805-844-9565
Mailing Address - Fax:
Practice Address - Street 1:4475 DUPONT CT
Practice Address - Street 2:SUITE 9
Practice Address - City:VENTURA
Practice Address - State:CA
Practice Address - Zip Code:93003-7745
Practice Address - Country:US
Practice Address - Phone:805-477-0939
Practice Address - Fax:805-477-0999
Is Sole Proprietor?:No
Enumeration Date:2007-06-25
Last Update Date:2012-06-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO8513OtherLICENSE#
CAPT 6812OtherCALIFORNIA LICENSE