Provider Demographics
NPI:1972646719
Name:MOFFITT, CAROLE MALLONEE (PT)
Entity Type:Individual
Prefix:MRS
First Name:CAROLE
Middle Name:MALLONEE
Last Name:MOFFITT
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 1:5295 STARLINE DR
Mailing Address - Street 2:
Mailing Address - City:SAINT CLOUD
Mailing Address - State:FL
Mailing Address - Zip Code:34771-9030
Mailing Address - Country:US
Mailing Address - Phone:407-791-6943
Mailing Address - Fax:407-957-1706
Practice Address - Street 1:1361 E IRLO BRONSON MEMORIAL HWY
Practice Address - Street 2:
Practice Address - City:SAINT CLOUD
Practice Address - State:FL
Practice Address - Zip Code:34771-5823
Practice Address - Country:US
Practice Address - Phone:407-957-1454
Practice Address - Fax:407-957-1706
Is Sole Proprietor?:No
Enumeration Date:2007-02-14
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPT 3010225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist