Provider Demographics
NPI:1881773141
Name:CLOHESSY, CAROLE ANN (PT)
Entity type:Individual
Prefix:
First Name:CAROLE
Middle Name:ANN
Last Name:CLOHESSY
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4210 W CASTLETON CT
Mailing Address - Street 2:
Mailing Address - City:MUNCIE
Mailing Address - State:IN
Mailing Address - Zip Code:47304-2410
Mailing Address - Country:US
Mailing Address - Phone:765-744-8719
Mailing Address - Fax:765-254-9000
Practice Address - Street 1:4210 W CASTLETON CT
Practice Address - Street 2:
Practice Address - City:MUNCIE
Practice Address - State:IN
Practice Address - Zip Code:47304-2410
Practice Address - Country:US
Practice Address - Phone:765-744-8719
Practice Address - Fax:765-254-9000
Is Sole Proprietor?:No
Enumeration Date:2006-11-06
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN05002337A225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist