Provider Demographics
NPI:1780714337
Name:GWALTNEY, CAROLINE SUSANNE (MS,PT)
Entity type:Individual
Prefix:
First Name:CAROLINE
Middle Name:SUSANNE
Last Name:GWALTNEY
Suffix:
Gender:F
Credentials:MS,PT
Other - Prefix:
Other - First Name:CAROLINE
Other - Middle Name:SUSANNE
Other - Last Name:KUETHER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:50120 AIRPORT PARK RD
Mailing Address - Street 2:
Mailing Address - City:HANCOCK
Mailing Address - State:MI
Mailing Address - Zip Code:49930-9360
Mailing Address - Country:US
Mailing Address - Phone:906-483-3777
Mailing Address - Fax:
Practice Address - Street 1:540 DEPOT ST
Practice Address - Street 2:
Practice Address - City:HANCOCK
Practice Address - State:MI
Practice Address - Zip Code:49930-2031
Practice Address - Country:US
Practice Address - Phone:906-482-7382
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-03-06
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5501009454225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist