Provider Demographics
NPI:1205031994
Name:STRAUB, CAROLE LENORE (MS,PT)
Entity Type:Individual
Prefix:
First Name:CAROLE
Middle Name:LENORE
Last Name:STRAUB
Suffix:
Gender:F
Credentials:MS,PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10627 ASHTON AVE
Mailing Address - Street 2:#301
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90024-5096
Mailing Address - Country:US
Mailing Address - Phone:323-559-4102
Mailing Address - Fax:
Practice Address - Street 1:133 N PRAIRIE AVE
Practice Address - Street 2:SUITE A
Practice Address - City:INGLEWOOD
Practice Address - State:CA
Practice Address - Zip Code:90301-4878
Practice Address - Country:US
Practice Address - Phone:310-673-9861
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-06-20
Last Update Date:2008-02-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPT244662251X0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2251X0800XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistOrthopedic
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAWPT24466BMedicare ID - Type UnspecifiedINDIVIDUAL
CAW16613AMedicare ID - Type UnspecifiedGROUP