Provider Demographics
NPI:1679638662
Name:BARICHIEVICH, CAROLINE SUZANNE (MS, PT)
Entity type:Individual
Prefix:
First Name:CAROLINE
Middle Name:SUZANNE
Last Name:BARICHIEVICH
Suffix:
Gender:F
Credentials:MS, PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:220 CONCOURSE BLVD
Mailing Address - Street 2:
Mailing Address - City:SANTA ROSA
Mailing Address - State:CA
Mailing Address - Zip Code:95403-8210
Mailing Address - Country:US
Mailing Address - Phone:844-527-7369
Mailing Address - Fax:844-847-4943
Practice Address - Street 1:220 CONCOURSE BLVD
Practice Address - Street 2:
Practice Address - City:SANTA ROSA
Practice Address - State:CA
Practice Address - Zip Code:95403-8210
Practice Address - Country:US
Practice Address - Phone:844-527-7369
Practice Address - Fax:844-847-4943
Is Sole Proprietor?:No
Enumeration Date:2006-12-27
Last Update Date:2024-05-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA24547225100000X
NV1381225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist