Provider Demographics
NPI:1356096317
Name:NIELSEN, CAROLYN (PT, DPT)
Entity Type:Individual
Prefix:
First Name:CAROLYN
Middle Name:
Last Name:NIELSEN
Suffix:
Gender:F
Credentials:PT, DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1841 E SUMMIT STREET
Mailing Address - Street 2:
Mailing Address - City:CROWN POINT
Mailing Address - State:IN
Mailing Address - Zip Code:46307-2768
Mailing Address - Country:US
Mailing Address - Phone:219-801-7777
Mailing Address - Fax:219-801-7677
Practice Address - Street 1:1841 E SUMMIT STREET
Practice Address - Street 2:
Practice Address - City:CROWN POINT
Practice Address - State:IN
Practice Address - Zip Code:46307-2768
Practice Address - Country:US
Practice Address - Phone:219-801-7777
Practice Address - Fax:219-801-7677
Is Sole Proprietor?:No
Enumeration Date:2022-02-18
Last Update Date:2022-03-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN05014457A225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist