Provider Demographics
NPI:1831288984
Name:CARONELLO, CARRIE L (PT)
Entity Type:Individual
Prefix:MRS
First Name:CARRIE
Middle Name:L
Last Name:CARONELLO
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 1:1650 LILIHA ST STE 107
Mailing Address - Street 2:
Mailing Address - City:HONOLULU
Mailing Address - State:HI
Mailing Address - Zip Code:96817-3169
Mailing Address - Country:US
Mailing Address - Phone:808-536-6117
Mailing Address - Fax:808-587-7727
Practice Address - Street 1:803 KAMEHAMEHA HWY STE 310
Practice Address - Street 2:
Practice Address - City:PEARL CITY
Practice Address - State:HI
Practice Address - Zip Code:96782-2638
Practice Address - Country:US
Practice Address - Phone:808-456-8885
Practice Address - Fax:808-587-7727
Is Sole Proprietor?:No
Enumeration Date:2006-10-12
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
HI857225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
HI58331101Medicaid