Provider Demographics
NPI:1992142194
Name:CHAPMAN, CARRIE LYNN (PT)
Entity type:Individual
Prefix:MRS
First Name:CARRIE
Middle Name:LYNN
Last Name:CHAPMAN
Suffix:
Gender:F
Credentials:PT
Other - Prefix:MISS
Other - First Name:CARRIE
Other - Middle Name:LYNN
Other - Last Name:DOMBROSKI
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:351 S STRAITS HWY
Mailing Address - Street 2:
Mailing Address - City:INDIAN RIVER
Mailing Address - State:MI
Mailing Address - Zip Code:49749-9713
Mailing Address - Country:US
Mailing Address - Phone:231-238-2302
Mailing Address - Fax:231-238-2303
Practice Address - Street 1:351 S STRAITS HWY
Practice Address - Street 2:
Practice Address - City:INDIAN RIVER
Practice Address - State:MI
Practice Address - Zip Code:49749-9713
Practice Address - Country:US
Practice Address - Phone:231-238-2302
Practice Address - Fax:231-238-2303
Is Sole Proprietor?:Yes
Enumeration Date:2013-05-29
Last Update Date:2013-05-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5501016308225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist