Provider Demographics
NPI:1568502250
Name:GUILFOYLE, CARRIE SUZANNE
Entity type:Individual
Prefix:
First Name:CARRIE
Middle Name:SUZANNE
Last Name:GUILFOYLE
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:CARRIE
Other - Middle Name:SUZANNE
Other - Last Name:MULLEN
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:2421 SW CABIN CAMP LN
Mailing Address - Street 2:
Mailing Address - City:LEES SUMMIT
Mailing Address - State:MO
Mailing Address - Zip Code:64082-4189
Mailing Address - Country:US
Mailing Address - Phone:816-525-9356
Mailing Address - Fax:816-525-0978
Practice Address - Street 1:2133 NW 13TH ST
Practice Address - Street 2:
Practice Address - City:BLUE SPRINGS
Practice Address - State:MO
Practice Address - Zip Code:64015-7734
Practice Address - Country:US
Practice Address - Phone:816-224-0003
Practice Address - Fax:816-224-2199
Is Sole Proprietor?:No
Enumeration Date:2007-02-08
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2001017951225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist