Provider Demographics
NPI:1780909929
Name:CARAWAY, NANCY (PTA)
Entity type:Individual
Prefix:
First Name:NANCY
Middle Name:
Last Name:CARAWAY
Suffix:
Gender:F
Credentials:PTA
Other - Prefix:
Other - First Name:NANCY
Other - Middle Name:K
Other - Last Name:CLEAVELAND
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PTA
Mailing Address - Street 1:PO BOX 3497
Mailing Address - Street 2:
Mailing Address - City:STURTEVANT
Mailing Address - State:WI
Mailing Address - Zip Code:53177-0300
Mailing Address - Country:US
Mailing Address - Phone:888-201-1040
Mailing Address - Fax:866-245-8064
Practice Address - Street 1:4323 MILTON AVE STE 201
Practice Address - Street 2:
Practice Address - City:JANESVILLE
Practice Address - State:WI
Practice Address - Zip Code:53546-9802
Practice Address - Country:US
Practice Address - Phone:608-757-1840
Practice Address - Fax:866-245-8064
Is Sole Proprietor?:No
Enumeration Date:2010-03-31
Last Update Date:2010-03-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI96319225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant