Provider Demographics
NPI:1366845661
Name:MAGOULAS, CARRIE LYNNE (PT, DPT)
Entity Type:Individual
Prefix:MRS
First Name:CARRIE
Middle Name:LYNNE
Last Name:MAGOULAS
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 1:136 CORPORATE PARK DR
Mailing Address - Street 2:SUITE A
Mailing Address - City:MOORESVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:28117-6959
Mailing Address - Country:US
Mailing Address - Phone:704-360-2796
Mailing Address - Fax:
Practice Address - Street 1:136 CORPORATE PARK DR
Practice Address - Street 2:SUITE A
Practice Address - City:MOORESVILLE
Practice Address - State:NC
Practice Address - Zip Code:28117-6959
Practice Address - Country:US
Practice Address - Phone:704-360-2796
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-09-30
Last Update Date:2014-09-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC14854225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist