Provider Demographics
NPI:1700150356
Name:MURPHY, CAROLYN C
Entity Type:Individual
Prefix:MS
First Name:CAROLYN
Middle Name:C
Last Name:MURPHY
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:60 OLD PONSETT RD
Mailing Address - Street 2:
Mailing Address - City:HADDAM
Mailing Address - State:CT
Mailing Address - Zip Code:06438-1023
Mailing Address - Country:US
Mailing Address - Phone:562-256-7550
Mailing Address - Fax:
Practice Address - Street 1:60 OLD PONSETT RD
Practice Address - Street 2:
Practice Address - City:HADDAM
Practice Address - State:CT
Practice Address - Zip Code:06438-1023
Practice Address - Country:US
Practice Address - Phone:562-256-7550
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-02-29
Last Update Date:2012-02-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA38508225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA38508Medicaid
CA38508Medicare PIN