Provider Demographics
NPI:1215981899
Name:KINNEMAN, CAROL ANN (PT)
Entity type:Individual
Prefix:
First Name:CAROL
Middle Name:ANN
Last Name:KINNEMAN
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 1:2718 HENRY ST
Mailing Address - Street 2:
Mailing Address - City:GREENSBORO
Mailing Address - State:NC
Mailing Address - Zip Code:27405-3633
Mailing Address - Country:US
Mailing Address - Phone:336-375-1007
Mailing Address - Fax:336-375-9615
Practice Address - Street 1:2718 HENRY ST
Practice Address - Street 2:
Practice Address - City:GREENSBORO
Practice Address - State:NC
Practice Address - Zip Code:27405-3633
Practice Address - Country:US
Practice Address - Phone:336-375-1007
Practice Address - Fax:336-375-9615
Is Sole Proprietor?:No
Enumeration Date:2006-05-19
Last Update Date:2015-09-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC8490225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC078MXOtherBCBSNC
NC7211470Medicaid
NC078MXOtherBCBSNC