Provider Demographics
NPI:1306841846
Name:STRATTON, CAROL LYNNE (MSPT, ATC)
Entity Type:Individual
Prefix:
First Name:CAROL
Middle Name:LYNNE
Last Name:STRATTON
Suffix:
Gender:F
Credentials:MSPT, ATC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:790 REMINGTON BLVD
Mailing Address - Street 2:
Mailing Address - City:BOLINGBROOK
Mailing Address - State:IL
Mailing Address - Zip Code:60440-4909
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:900 CENTENNIAL BLVD STE 203
Practice Address - Street 2:
Practice Address - City:VOORHEES
Practice Address - State:NJ
Practice Address - Zip Code:08043-4637
Practice Address - Country:US
Practice Address - Phone:856-325-6677
Practice Address - Fax:856-325-6678
Is Sole Proprietor?:No
Enumeration Date:2005-06-20
Last Update Date:2023-12-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ4OQA010743002251X0800X
225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
No2251X0800XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistOrthopedic
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ3966715OtherAETNA
NJ42394OtherUNIVERSITY HEALTHPLAN
NJ1140175000OtherUS DEPT OF LABOR
NJ1584381OtherAMERIHEALTH PPO
NJ2263065000OtherAMERIHEALTH/KEYSTON/IBC
NJP3054111OtherOXFORD
PA1584381OtherPA BLUE SHIELD
NJ1959450OtherUNITED HEALTHCARE
NJ072178 DSTMedicare PIN