Provider Demographics
NPI:1861473142
Name:MUSFELDT, CAROLYN KIMPEL (PT)
Entity Type:Individual
Prefix:
First Name:CAROLYN
Middle Name:KIMPEL
Last Name:MUSFELDT
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:MARY
Other - Middle Name:CAROLYN
Other - Last Name:KIMPEL
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:PO BOX 105132
Mailing Address - Street 2:
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30348-5132
Mailing Address - Country:US
Mailing Address - Phone:615-329-2294
Mailing Address - Fax:
Practice Address - Street 1:301 21ST AVE N
Practice Address - Street 2:
Practice Address - City:NASHVILLE
Practice Address - State:TN
Practice Address - Zip Code:37203-1821
Practice Address - Country:US
Practice Address - Phone:615-329-6600
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2005-11-14
Last Update Date:2012-07-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNPT661225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN3658325Medicaid
TN0406260001Medicare NSC
TN3658325Medicare PIN