Provider Demographics
NPI:1023598703
Name:CARLSON, CAROLINE GOFORTH (PT)
Entity type:Individual
Prefix:MRS
First Name:CAROLINE
Middle Name:GOFORTH
Last Name:CARLSON
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 1:470 STONEYFIELD DR
Mailing Address - Street 2:
Mailing Address - City:SOUTHERN PINES
Mailing Address - State:NC
Mailing Address - Zip Code:28387-7161
Mailing Address - Country:US
Mailing Address - Phone:910-633-2517
Mailing Address - Fax:
Practice Address - Street 1:500 E RHODE ISLAND AVE
Practice Address - Street 2:
Practice Address - City:SOUTHERN PINES
Practice Address - State:NC
Practice Address - Zip Code:28387-4010
Practice Address - Country:US
Practice Address - Phone:910-692-0371
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-08-21
Last Update Date:2018-08-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCP13360225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist