Provider Demographics
NPI:1790170512
Name:WOLVERTON, KARMEN R (PT)
Entity Type:Individual
Prefix:
First Name:KARMEN
Middle Name:R
Last Name:WOLVERTON
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:25550 JUBAN RD
Mailing Address - Street 2:SUITE B
Mailing Address - City:DENHAM SPRINGS
Mailing Address - State:LA
Mailing Address - Zip Code:70726-6149
Mailing Address - Country:US
Mailing Address - Phone:225-665-8600
Mailing Address - Fax:225-665-8009
Practice Address - Street 1:25550 JUBAN RD
Practice Address - Street 2:SUITE B
Practice Address - City:DENHAM SPRINGS
Practice Address - State:LA
Practice Address - Zip Code:70726-6149
Practice Address - Country:US
Practice Address - Phone:225-665-8600
Practice Address - Fax:225-665-8009
Is Sole Proprietor?:Yes
Enumeration Date:2015-03-30
Last Update Date:2015-03-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist