Provider Demographics
NPI:1437423829
Name:MADER, CAROLYN N (DPT)
Entity Type:Individual
Prefix:
First Name:CAROLYN
Middle Name:N
Last Name:MADER
Suffix:
Gender:F
Credentials:DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5300 DERRY ST
Mailing Address - Street 2:2ND FLOOR
Mailing Address - City:HARRISBURG
Mailing Address - State:PA
Mailing Address - Zip Code:17111-3576
Mailing Address - Country:US
Mailing Address - Phone:717-839-2110
Mailing Address - Fax:717-565-1934
Practice Address - Street 1:2805 OLD POST RD
Practice Address - Street 2:SUITE 110
Practice Address - City:HARRISBURG
Practice Address - State:PA
Practice Address - Zip Code:17110-3675
Practice Address - Country:US
Practice Address - Phone:717-635-2030
Practice Address - Fax:717-635-2029
Is Sole Proprietor?:No
Enumeration Date:2012-03-02
Last Update Date:2016-10-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAPT-019454225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist