Provider Demographics
NPI:1578733754
Name:STAUDUHAR, KAROLEE (PT)
Entity type:Individual
Prefix:
First Name:KAROLEE
Middle Name:
Last Name:STAUDUHAR
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 1:598 RIVER FOREST RUN
Mailing Address - Street 2:
Mailing Address - City:CLEVELAND
Mailing Address - State:GA
Mailing Address - Zip Code:30528-3181
Mailing Address - Country:US
Mailing Address - Phone:407-718-7531
Mailing Address - Fax:
Practice Address - Street 1:130 MAIN ST
Practice Address - Street 2:
Practice Address - City:CLERMONT
Practice Address - State:GA
Practice Address - Zip Code:30527-1804
Practice Address - Country:US
Practice Address - Phone:678-616-3099
Practice Address - Fax:770-406-6840
Is Sole Proprietor?:Yes
Enumeration Date:2008-03-04
Last Update Date:2024-08-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPT 6592225100000X
GAPT010466225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist