Provider Demographics
NPI:1770959553
Name:MAHER, CAROLYN MICHELLE (PT, DPT)
Entity type:Individual
Prefix:MRS
First Name:CAROLYN
Middle Name:MICHELLE
Last Name:MAHER
Suffix:
Gender:F
Credentials:PT, DPT
Other - Prefix:MS
Other - First Name:CAROLYN
Other - Middle Name:MICHELLE
Other - Last Name:SOBIESKI
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PT, DPT
Mailing Address - Street 1:507 E ARMSTRONG AVE
Mailing Address - Street 2:
Mailing Address - City:PEORIA
Mailing Address - State:IL
Mailing Address - Zip Code:61603-3201
Mailing Address - Country:US
Mailing Address - Phone:309-686-1177
Mailing Address - Fax:309-686-7722
Practice Address - Street 1:507 E ARMSTRONG AVE
Practice Address - Street 2:
Practice Address - City:PEORIA
Practice Address - State:IL
Practice Address - Zip Code:61603
Practice Address - Country:US
Practice Address - Phone:309-686-1177
Practice Address - Fax:309-686-7722
Is Sole Proprietor?:No
Enumeration Date:2015-08-17
Last Update Date:2021-12-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL070021533225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist