Provider Demographics
NPI:1013167881
Name:COUNTRYMAN, CAROLYN W (PT)
Entity type:Individual
Prefix:
First Name:CAROLYN
Middle Name:W
Last Name:COUNTRYMAN
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:CAROLYN
Other - Middle Name:W
Other - Last Name:FAUGHNAN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PT
Mailing Address - Street 1:12 NORWOOD AVE
Mailing Address - Street 2:
Mailing Address - City:MONROE TOWNSHIP
Mailing Address - State:NJ
Mailing Address - Zip Code:08831-8517
Mailing Address - Country:US
Mailing Address - Phone:732-672-0315
Mailing Address - Fax:732-972-5458
Practice Address - Street 1:12 NORWOOD AVE
Practice Address - Street 2:
Practice Address - City:MONROE TOWNSHIP
Practice Address - State:NJ
Practice Address - Zip Code:08831-8517
Practice Address - Country:US
Practice Address - Phone:732-672-0315
Practice Address - Fax:732-972-5458
Is Sole Proprietor?:No
Enumeration Date:2008-09-29
Last Update Date:2025-05-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ40QA00295000225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist