Basic Information
| Provider Information | |||||||||
| NPI: | 1043749153 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | EGLOFF | ||||||||
| FirstName: | CAROLINE | ||||||||
| MiddleName: | THOMSEN | ||||||||
| NamePrefix: | DR. | ||||||||
| NameSuffix: | |||||||||
| Credential: | PT, DPT | ||||||||
| OtherOrganizationName: | |||||||||
| OtherOrganizationType: | |||||||||
| OtherLastName: | THOMSEN | ||||||||
| OtherFirstName: | CAROLINE | ||||||||
| OtherMiddleName: | ELIZABETH | ||||||||
| OtherNamePrefix: | |||||||||
| OtherNameSuffix: | |||||||||
| OtherCredential: | PT, DPT | ||||||||
| OtherLastNameType: | 1 | ||||||||
| Mailing Information | |||||||||
| Address1: | 815 E MAIN ST | ||||||||
| Address2: | |||||||||
| City: | FLOYD | ||||||||
| State: | VA | ||||||||
| PostalCode: | 240913750 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5407455005 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | 815 E MAIN ST | ||||||||
| Address2: | |||||||||
| City: | FLOYD | ||||||||
| State: | VA | ||||||||
| PostalCode: | 24091 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5407455005 | ||||||||
| FaxNumber: | 5407455005 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 06/12/2017 | ||||||||
| LastUpdateDate: | 07/17/2018 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| AuthorizedOfficialMiddleName: | |||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | |||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 225100000X | 2305211204 | VA | Y | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Physical Therapist |
No ID Information.