Provider Demographics
NPI:1982913851
Name:ADIE, CAROLYN G (PHYSICAL THERAPIST)
Entity Type:Individual
Prefix:
First Name:CAROLYN
Middle Name:G
Last Name:ADIE
Suffix:
Gender:F
Credentials:PHYSICAL THERAPIST
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 3778
Mailing Address - Street 2:
Mailing Address - City:EDGEWOOD
Mailing Address - State:NM
Mailing Address - Zip Code:87015-3778
Mailing Address - Country:US
Mailing Address - Phone:505-281-7848
Mailing Address - Fax:
Practice Address - Street 1:1090 MOUNTAIN VALLEY RD
Practice Address - Street 2:
Practice Address - City:EDGEWOOD
Practice Address - State:NM
Practice Address - Zip Code:87015-8044
Practice Address - Country:US
Practice Address - Phone:505-281-1811
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-09-27
Last Update Date:2010-09-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NM1049225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist