Provider Demographics
NPI:1225341928
Name:VLASS, CAROLYN M (PT)
Entity Type:Individual
Prefix:
First Name:CAROLYN
Middle Name:M
Last Name:VLASS
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:CAROLYN
Other - Middle Name:M
Other - Last Name:PSCHANDL
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PT
Mailing Address - Street 1:PO BOX 1772
Mailing Address - Street 2:
Mailing Address - City:CRESTVIEW
Mailing Address - State:FL
Mailing Address - Zip Code:32536-7772
Mailing Address - Country:US
Mailing Address - Phone:850-682-7772
Mailing Address - Fax:850-682-1539
Practice Address - Street 1:728 N FERDON BLVD
Practice Address - Street 2:STE #3
Practice Address - City:CRESTVIEW
Practice Address - State:FL
Practice Address - Zip Code:32536-2155
Practice Address - Country:US
Practice Address - Phone:850-682-7772
Practice Address - Fax:850-682-1539
Is Sole Proprietor?:No
Enumeration Date:2010-07-22
Last Update Date:2015-04-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPT25681225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist