Provider Demographics
NPI:1225604622
Name:MOHUN, KARLIE (PT, DPT, ATC)
Entity Type:Individual
Prefix:
First Name:KARLIE
Middle Name:
Last Name:MOHUN
Suffix:
Gender:F
Credentials:PT, DPT, ATC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:211 EDGEWATER RD APT 32
Mailing Address - Street 2:
Mailing Address - City:SAVANNAH
Mailing Address - State:GA
Mailing Address - Zip Code:31406-5326
Mailing Address - Country:US
Mailing Address - Phone:530-386-3176
Mailing Address - Fax:
Practice Address - Street 1:990 RIBAUT RD
Practice Address - Street 2:
Practice Address - City:BEAUFORT
Practice Address - State:SC
Practice Address - Zip Code:29902-8011
Practice Address - Country:US
Practice Address - Phone:843-522-5899
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-05-27
Last Update Date:2021-05-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GAPT015199225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist