Provider Demographics
NPI:1447088604
Name:PRAUGHT, CAROLINE LOIS (PTA)
Entity type:Individual
Prefix:
First Name:CAROLINE
Middle Name:LOIS
Last Name:PRAUGHT
Suffix:
Gender:F
Credentials:PTA
Other - Prefix:MISS
Other - First Name:CAROLINE
Other - Middle Name:LOIS
Other - Last Name:PRAUGHT
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:PTA
Mailing Address - Street 1:50 NORRIS RD
Mailing Address - Street 2:
Mailing Address - City:POUGHKEEPSIE
Mailing Address - State:AR
Mailing Address - Zip Code:72569-9304
Mailing Address - Country:US
Mailing Address - Phone:870-844-0450
Mailing Address - Fax:
Practice Address - Street 1:1310 SIDNEY ST
Practice Address - Street 2:
Practice Address - City:BATESVILLE
Practice Address - State:AR
Practice Address - Zip Code:72501-7628
Practice Address - Country:US
Practice Address - Phone:870-612-7200
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-07-22
Last Update Date:2024-07-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AR4952225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant