Basic Information
| Provider Information | |||||||||
| NPI: | 1457574725 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | TRADER | ||||||||
| FirstName: | CAROLYN | ||||||||
| MiddleName: | LEE | ||||||||
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| Credential: | P.T. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 32120 MORRIS LEONARD RD | ||||||||
| Address2: | |||||||||
| City: | PARSONSBURG | ||||||||
| State: | MD | ||||||||
| PostalCode: | 218492522 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4105434820 | ||||||||
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| Practice Location | |||||||||
| Address1: | 200 CIVIC AVE | ||||||||
| Address2: | |||||||||
| City: | SALISBURY | ||||||||
| State: | MD | ||||||||
| PostalCode: | 218044599 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4107491466 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 04/11/2007 | ||||||||
| LastUpdateDate: | 07/08/2007 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 225100000X | 17178 | MD | Y | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Physical Therapist | 225100000X | J1-0000824 | DE | N | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Physical Therapist |
No ID Information.