Provider Demographics
NPI:1639134273
Name:HESS, CAROL SUE (PT)
Entity Type:Individual
Prefix:
First Name:CAROL
Middle Name:SUE
Last Name:HESS
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:CAROL
Other - Middle Name:SUE
Other - Last Name:HAAKENSON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PT
Mailing Address - Street 1:PO BOX 2024
Mailing Address - Street 2:
Mailing Address - City:COTTONWOOD
Mailing Address - State:AZ
Mailing Address - Zip Code:86326-2024
Mailing Address - Country:US
Mailing Address - Phone:928-639-3068
Mailing Address - Fax:928-639-3346
Practice Address - Street 1:825 W MINGUS AVE
Practice Address - Street 2:
Practice Address - City:COTTONWOOD
Practice Address - State:AZ
Practice Address - Zip Code:86326-4088
Practice Address - Country:US
Practice Address - Phone:928-639-3068
Practice Address - Fax:928-639-3346
Is Sole Proprietor?:No
Enumeration Date:2006-04-18
Last Update Date:2008-07-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
225100000X
AZ8079225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ338486Medicaid
WA5742HAOtherREGENCE BLUE SHIELD
WA650021418OtherRAILROAD MEDICARE
WA8336380Medicaid
WA8928851OtherL&I CRIME VICTIMS
WA911745305-98208-A002OtherTRICARE
WA0144100OtherDEPT. OF LABOR & INDUS.
WA4412893OtherAETNA
WA911745305-98208-A002OtherTRICARE