Provider Demographics
NPI:1518509660
Name:KO, CAROLINE (DPT)
Entity Type:Individual
Prefix:
First Name:CAROLINE
Middle Name:
Last Name:KO
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 1:1 WASHINGTON ST STE 4106
Mailing Address - Street 2:
Mailing Address - City:DOVER
Mailing Address - State:NH
Mailing Address - Zip Code:03820-2243
Mailing Address - Country:US
Mailing Address - Phone:603-605-6116
Mailing Address - Fax:603-343-2130
Practice Address - Street 1:915 COMMONWEALTH AVE REAR
Practice Address - Street 2:
Practice Address - City:BOSTON
Practice Address - State:MA
Practice Address - Zip Code:02215-1394
Practice Address - Country:US
Practice Address - Phone:617-358-3700
Practice Address - Fax:617-358-3710
Is Sole Proprietor?:No
Enumeration Date:2019-10-10
Last Update Date:2019-10-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA24345225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist