Provider Demographics
NPI:1821196635
Name:BERCAW, CAROL LYNN (PT)
Entity Type:Individual
Prefix:MRS
First Name:CAROL
Middle Name:LYNN
Last Name:BERCAW
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:4561 CARTHAGE CIR N
Mailing Address - Street 2:
Mailing Address - City:LAKE WORTH
Mailing Address - State:FL
Mailing Address - Zip Code:33463-7205
Mailing Address - Country:US
Mailing Address - Phone:561-683-9991
Mailing Address - Fax:561-683-4472
Practice Address - Street 1:2250 PALM BEACH LAKES BLVD
Practice Address - Street 2:SUITE # 109
Practice Address - City:WEST PALM BEACH
Practice Address - State:FL
Practice Address - Zip Code:33409-3407
Practice Address - Country:US
Practice Address - Phone:561-683-9991
Practice Address - Fax:561-683-4472
Is Sole Proprietor?:No
Enumeration Date:2006-09-20
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPT4758225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist