Provider Demographics
NPI:1114176807
Name:MUNSON, CAROLOU A (PT)
Entity Type:Individual
Prefix:MRS
First Name:CAROLOU
Middle Name:A
Last Name:MUNSON
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 1:5845 VIA ROMERO
Mailing Address - Street 2:
Mailing Address - City:YORBA LINDA
Mailing Address - State:CA
Mailing Address - Zip Code:92887-3430
Mailing Address - Country:US
Mailing Address - Phone:714-779-7009
Mailing Address - Fax:
Practice Address - Street 1:5845 VIA ROMERO
Practice Address - Street 2:
Practice Address - City:YORBA LINDA
Practice Address - State:CA
Practice Address - Zip Code:92887-3430
Practice Address - Country:US
Practice Address - Phone:714-779-7009
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-09-17
Last Update Date:2008-09-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPT 69172251G0304X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2251G0304XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGeriatricsGroup - Single Specialty