Provider Demographics
NPI:1629658430
Name:COONEY, CARYN (LMT)
Entity Type:Individual
Prefix:
First Name:CARYN
Middle Name:
Last Name:COONEY
Suffix:
Gender:F
Credentials:LMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:114 DEERPATH TRL
Mailing Address - Street 2:
Mailing Address - City:SUMMERVILLE
Mailing Address - State:SC
Mailing Address - Zip Code:29486-8362
Mailing Address - Country:US
Mailing Address - Phone:843-901-9135
Mailing Address - Fax:
Practice Address - Street 1:CARYN COONEY, LMT
Practice Address - Street 2:302 MIDLAND PARKWAY, SUITE A4
Practice Address - City:SUMMERVILLE
Practice Address - State:SC
Practice Address - Zip Code:29485-2948
Practice Address - Country:US
Practice Address - Phone:843-901-9135
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-04-14
Last Update Date:2021-04-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SCMAS.5593225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist