Provider Demographics
NPI:1912253212
Name:CARAWAY, CARON SUZANNE (LMT)
Entity Type:Individual
Prefix:MS
First Name:CARON
Middle Name:SUZANNE
Last Name:CARAWAY
Suffix:
Gender:F
Credentials:LMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5217 CAMINO DEL SOL NE APT D
Mailing Address - Street 2:SUITE A
Mailing Address - City:ALBUQUERQUE
Mailing Address - State:NM
Mailing Address - Zip Code:87111-2053
Mailing Address - Country:US
Mailing Address - Phone:505-850-0872
Mailing Address - Fax:
Practice Address - Street 1:5345 WYOMING BLVD NE STE 104
Practice Address - Street 2:
Practice Address - City:ALBUQUERQUE
Practice Address - State:NM
Practice Address - Zip Code:87109-3193
Practice Address - Country:US
Practice Address - Phone:505-850-0872
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-07-24
Last Update Date:2013-11-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NM7141172M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes172M00000XOther Service ProvidersMechanotherapist