Provider Demographics
NPI:1407304116
Name:WUST, CAROLINE H (DPT)
Entity Type:Individual
Prefix:
First Name:CAROLINE
Middle Name:H
Last Name:WUST
Suffix:
Gender:F
Credentials:DPT
Other - Prefix:
Other - First Name:CAROLINE
Other - Middle Name:E
Other - Last Name:HALL
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DPT
Mailing Address - Street 1:2405 ATHERHOLT RD
Mailing Address - Street 2:
Mailing Address - City:LYNCHBURG
Mailing Address - State:VA
Mailing Address - Zip Code:24501-2184
Mailing Address - Country:US
Mailing Address - Phone:434-485-8517
Mailing Address - Fax:434-485-8594
Practice Address - Street 1:2405 ATHERHOLT ROAD
Practice Address - Street 2:
Practice Address - City:LYNCHBURG
Practice Address - State:VA
Practice Address - Zip Code:24501-2184
Practice Address - Country:US
Practice Address - Phone:434-485-8517
Practice Address - Fax:434-485-8594
Is Sole Proprietor?:Yes
Enumeration Date:2016-09-12
Last Update Date:2021-08-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA2305210502225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist