Provider Demographics
NPI:1902086077
Name:POWELL, CAROL (PT)
Entity Type:Individual
Prefix:
First Name:CAROL
Middle Name:
Last Name:POWELL
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 1:19510 VENTURA BLVD
Mailing Address - Street 2:SUITE 106
Mailing Address - City:TARZANA
Mailing Address - State:CA
Mailing Address - Zip Code:91356-2969
Mailing Address - Country:US
Mailing Address - Phone:818-996-1725
Mailing Address - Fax:818-996-0210
Practice Address - Street 1:19510 VENTURA BLVD
Practice Address - Street 2:SUITE 106
Practice Address - City:TARZANA
Practice Address - State:CA
Practice Address - Zip Code:91356-2969
Practice Address - Country:US
Practice Address - Phone:818-996-1725
Practice Address - Fax:818-996-0210
Is Sole Proprietor?:No
Enumeration Date:2007-11-06
Last Update Date:2008-03-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPT5739225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAWPT5739AMedicare UPIN