Provider Demographics
NPI:1982806543
Name:KRAG, CAROL ANN (PT)
Entity Type:Individual
Prefix:MRS
First Name:CAROL
Middle Name:ANN
Last Name:KRAG
Suffix:
Gender:F
Credentials:PT
Other - Prefix:MISS
Other - First Name:CAROL
Other - Middle Name:ANN
Other - Last Name:BROWN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PT
Mailing Address - Street 1:416 GLENVIEW DR
Mailing Address - Street 2:
Mailing Address - City:GREENCASTLE
Mailing Address - State:IN
Mailing Address - Zip Code:46135-7489
Mailing Address - Country:US
Mailing Address - Phone:765-653-5494
Mailing Address - Fax:765-653-6110
Practice Address - Street 1:522 ANDERSON ST
Practice Address - Street 2:
Practice Address - City:GREENCASTLE
Practice Address - State:IN
Practice Address - Zip Code:46135-1729
Practice Address - Country:US
Practice Address - Phone:765-653-2781
Practice Address - Fax:765-653-6110
Is Sole Proprietor?:Yes
Enumeration Date:2007-06-04
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN05002753A225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist