Provider Demographics
NPI:1942599428
Name:CALDWELL, JERYL ROBIN (LPTA)
Entity Type:Individual
Prefix:MRS
First Name:JERYL
Middle Name:ROBIN
Last Name:CALDWELL
Suffix:
Gender:F
Credentials:LPTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2408 THORNGROVE CT
Mailing Address - Street 2:
Mailing Address - City:FAYETTEVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:28303-4099
Mailing Address - Country:US
Mailing Address - Phone:910-920-3858
Mailing Address - Fax:
Practice Address - Street 1:1601 PURDUE DR
Practice Address - Street 2:
Practice Address - City:FAYETTEVILLE
Practice Address - State:NC
Practice Address - Zip Code:28304-3674
Practice Address - Country:US
Practice Address - Phone:910-672-0061
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-04-05
Last Update Date:2011-04-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC655225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant