Provider Demographics
NPI:1558662239
Name:GO, KAROLYN ANN (RPT)
Entity Type:Individual
Prefix:
First Name:KAROLYN ANN
Middle Name:
Last Name:GO
Suffix:
Gender:F
Credentials:RPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7615 113TH ST APT 3C
Mailing Address - Street 2:
Mailing Address - City:FOREST HILLS
Mailing Address - State:NY
Mailing Address - Zip Code:11375-6551
Mailing Address - Country:US
Mailing Address - Phone:347-995-8944
Mailing Address - Fax:
Practice Address - Street 1:7615 113TH ST APT 3C
Practice Address - Street 2:
Practice Address - City:FOREST HILLS
Practice Address - State:NY
Practice Address - Zip Code:11375-6551
Practice Address - Country:US
Practice Address - Phone:347-995-8944
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-11-10
Last Update Date:2010-11-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY030786-1225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist