Provider Demographics
NPI:1962690578
Name:LAWLOR, CAROL CASSIDY (MED, PT, ATC, CSCS)
Entity type:Individual
Prefix:
First Name:CAROL
Middle Name:CASSIDY
Last Name:LAWLOR
Suffix:
Gender:F
Credentials:MED, PT, ATC, CSCS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:251 INDIAN POINT ST
Mailing Address - Street 2:
Mailing Address - City:NEWPORT
Mailing Address - State:VT
Mailing Address - Zip Code:05855-1519
Mailing Address - Country:US
Mailing Address - Phone:802-334-5858
Mailing Address - Fax:
Practice Address - Street 1:251 INDIAN POINT ST
Practice Address - Street 2:
Practice Address - City:NEWPORT
Practice Address - State:VT
Practice Address - Zip Code:05855-1519
Practice Address - Country:US
Practice Address - Phone:802-334-5858
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-10-09
Last Update Date:2007-10-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VT0400000908225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist