Provider Demographics
NPI:1821347261
Name:ENGDAHL, CAROLYN JEAN (DPT)
Entity Type:Individual
Prefix:
First Name:CAROLYN
Middle Name:JEAN
Last Name:ENGDAHL
Suffix:
Gender:F
Credentials:DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:195 KRUSHKA RD
Mailing Address - Street 2:
Mailing Address - City:SHICKSHINNY
Mailing Address - State:PA
Mailing Address - Zip Code:18655-4523
Mailing Address - Country:US
Mailing Address - Phone:570-542-7897
Mailing Address - Fax:
Practice Address - Street 1:195 KRUSHKA RD
Practice Address - Street 2:
Practice Address - City:SHICKSHINNY
Practice Address - State:PA
Practice Address - Zip Code:18655-4523
Practice Address - Country:US
Practice Address - Phone:570-542-7897
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-08-30
Last Update Date:2012-08-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAPT016418225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist