Provider Demographics
NPI:1083926240
Name:POWERS, CAROLINE WILLIS (DPT)
Entity Type:Individual
Prefix:MRS
First Name:CAROLINE
Middle Name:WILLIS
Last Name:POWERS
Suffix:
Gender:F
Credentials:DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4502 MILWAUKEE ST
Mailing Address - Street 2:
Mailing Address - City:MADISON
Mailing Address - State:WI
Mailing Address - Zip Code:53714-2133
Mailing Address - Country:US
Mailing Address - Phone:608-576-8763
Mailing Address - Fax:
Practice Address - Street 1:4502 MILWAUKEE ST
Practice Address - Street 2:
Practice Address - City:MADISON
Practice Address - State:WI
Practice Address - Zip Code:53714-2133
Practice Address - Country:US
Practice Address - Phone:608-576-8763
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-07-05
Last Update Date:2012-11-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI11531-24225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI1083926240Medicaid