Provider Demographics
NPI:1356355028
Name:CARDENAS, CAROL A (PT)
Entity type:Individual
Prefix:MS
First Name:CAROL
Middle Name:A
Last Name:CARDENAS
Suffix:
Gender:F
Credentials:PT
Other - Prefix:MS
Other - First Name:CAROL
Other - Middle Name:ANN
Other - Last Name:LEE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PT
Mailing Address - Street 1:13116 E MILLERTON RD
Mailing Address - Street 2:
Mailing Address - City:MOORPARK
Mailing Address - State:CA
Mailing Address - Zip Code:93021-2141
Mailing Address - Country:US
Mailing Address - Phone:310-924-4233
Mailing Address - Fax:805-733-1213
Practice Address - Street 1:1700 REGENCY PKWY
Practice Address - Street 2:
Practice Address - City:CARY
Practice Address - State:NC
Practice Address - Zip Code:27518-8533
Practice Address - Country:US
Practice Address - Phone:919-467-7779
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-28
Last Update Date:2023-06-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPT16081225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAPT16081OtherPHYSICAL THERAPY LICENSE