Provider Demographics
NPI:1427215193
Name:MUNN, CAROLYN RUTH (PT)
Entity Type:Individual
Prefix:MS
First Name:CAROLYN
Middle Name:RUTH
Last Name:MUNN
Suffix:
Gender:F
Credentials:PT
Other - Prefix:MS
Other - First Name:CAROLYN
Other - Middle Name:RUTH
Other - Last Name:URBAN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PT
Mailing Address - Street 1:91 ARIES LN
Mailing Address - Street 2:
Mailing Address - City:LA GRANDE
Mailing Address - State:OR
Mailing Address - Zip Code:97850-3309
Mailing Address - Country:US
Mailing Address - Phone:541-963-8678
Mailing Address - Fax:541-963-5024
Practice Address - Street 1:91 ARIES LN
Practice Address - Street 2:
Practice Address - City:LA GRANDE
Practice Address - State:OR
Practice Address - Zip Code:97850-3309
Practice Address - Country:US
Practice Address - Phone:541-963-8678
Practice Address - Fax:541-963-5024
Is Sole Proprietor?:Yes
Enumeration Date:2008-05-20
Last Update Date:2008-05-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR3704225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist