Provider Demographics
NPI:1952696163
Name:HARDOUIN, CAROLYN STAGG (PT)
Entity Type:Individual
Prefix:
First Name:CAROLYN
Middle Name:STAGG
Last Name:HARDOUIN
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 1:12914 FM 1960 RD W
Mailing Address - Street 2:SUITE F
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77065-5310
Mailing Address - Country:US
Mailing Address - Phone:832-237-3331
Mailing Address - Fax:832-237-4638
Practice Address - Street 1:12914 FM 1960 RD W
Practice Address - Street 2:SUITE F
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77065-5310
Practice Address - Country:US
Practice Address - Phone:832-237-3331
Practice Address - Fax:832-237-4638
Is Sole Proprietor?:Yes
Enumeration Date:2011-06-15
Last Update Date:2011-06-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX1137420225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX454874Medicare PIN