Provider Demographics
NPI:1710498522
Name:JOHNS, CAROL ANN (PT, CLT/LANA)
Entity Type:Individual
Prefix:
First Name:CAROL
Middle Name:ANN
Last Name:JOHNS
Suffix:
Gender:F
Credentials:PT, CLT/LANA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5920 SANDY FORKS RD STE 200
Mailing Address - Street 2:
Mailing Address - City:RALEIGH
Mailing Address - State:NC
Mailing Address - Zip Code:27609-3814
Mailing Address - Country:US
Mailing Address - Phone:919-954-3492
Mailing Address - Fax:919-954-3947
Practice Address - Street 1:5920 SANDY FORKS RD STE 200
Practice Address - Street 2:
Practice Address - City:RALEIGH
Practice Address - State:NC
Practice Address - Zip Code:27609-3814
Practice Address - Country:US
Practice Address - Phone:919-954-3492
Practice Address - Fax:919-954-3947
Is Sole Proprietor?:No
Enumeration Date:2017-10-19
Last Update Date:2017-10-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC3177225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC3177OtherNC BOARD OF PT EXAMINERS