Provider Demographics
NPI:1942539440
Name:SEALE, CAROLYN ANNETTE FONVILLE (DPT)
Entity Type:Individual
Prefix:
First Name:CAROLYN
Middle Name:ANNETTE FONVILLE
Last Name:SEALE
Suffix:
Gender:F
Credentials:DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:1515 SW CARY PKWY STE 120
Mailing Address - Street 2:
Mailing Address - City:CARY
Mailing Address - State:NC
Mailing Address - Zip Code:27511-6224
Mailing Address - Country:US
Mailing Address - Phone:919-784-4690
Mailing Address - Fax:919-784-4697
Practice Address - Street 1:1515 SW CARY PKWY STE 120
Practice Address - Street 2:
Practice Address - City:CARY
Practice Address - State:NC
Practice Address - Zip Code:27511-6224
Practice Address - Country:US
Practice Address - Phone:919-784-4690
Practice Address - Fax:919-784-4697
Is Sole Proprietor?:No
Enumeration Date:2009-12-11
Last Update Date:2024-02-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC10146225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist