Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 2251S0007X | Physical Therapist - Sports | 25878 | CA |
Y | 2251X0800X | Physical Therapist - Orthopedic | 12302 | NC |
NPI | 1356419360 |
---|---|
Provider Name | Carrie Ann Rubertino Shearer |
First Address | Chapel Hill, NC 27599-7470 |
Second Address | Chapel Hill, NC 27599-7470 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 30/11/2006 |
Last Update Date | 01/06/2010 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
079802470 | NATABOC (01) | |
12302 | PHYSICAL THERAPIST (01) | NC |
1629 | LICENSED ATHLETIC TRAINER (01) | NC |
25878 | PHYSICAL THERAPY (01) | CA |