Provider Demographics
NPI:1336743905
Name:DENTON, CAROLYN SUE (PT, DPT)
Entity Type:Individual
Prefix:DR
First Name:CAROLYN
Middle Name:SUE
Last Name:DENTON
Suffix:
Gender:F
Credentials:PT, DPT
Other - Prefix:DR
Other - First Name:CAROLYN
Other - Middle Name:SUE
Other - Last Name:EBBENS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PT, DPT
Mailing Address - Street 1:5113 LONG POINTE RD
Mailing Address - Street 2:
Mailing Address - City:WILMINGTON
Mailing Address - State:NC
Mailing Address - Zip Code:28409-3288
Mailing Address - Country:US
Mailing Address - Phone:219-776-9157
Mailing Address - Fax:
Practice Address - Street 1:5113 LONG POINTE RD
Practice Address - Street 2:
Practice Address - City:WILMINGTON
Practice Address - State:NC
Practice Address - Zip Code:28409-3288
Practice Address - Country:US
Practice Address - Phone:219-776-9157
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-11-24
Last Update Date:2020-11-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCP17867225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist