Provider Demographics
NPI:1497023394
Name:CAHN, CAROL B (PT)
Entity Type:Individual
Prefix:MRS
First Name:CAROL
Middle Name:B
Last Name:CAHN
Suffix:
Gender:F
Credentials:PT
Other - Prefix:MRS
Other - First Name:KEREN
Other - Middle Name:B
Other - Last Name:CAHN
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:PT
Mailing Address - Street 1:9 MOUNTAIN LODGE LN
Mailing Address - Street 2:
Mailing Address - City:MILL VALLEY
Mailing Address - State:CA
Mailing Address - Zip Code:94941-3732
Mailing Address - Country:US
Mailing Address - Phone:415-320-4451
Mailing Address - Fax:
Practice Address - Street 1:619 E BLITHEDALE AVE
Practice Address - Street 2:
Practice Address - City:MILL VALLEY
Practice Address - State:CA
Practice Address - Zip Code:94941-1482
Practice Address - Country:US
Practice Address - Phone:415-388-5223
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-12-06
Last Update Date:2011-12-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPT9951225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist