Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225200000X | Physical Therapy Assistant | PTA003860 | GA |
NPI | 1003330051 |
---|---|
Provider Name | Laura Elizabeth Carriero |
First Address | Chattanooga, TN 37421-2564 |
Second Address | Cleveland, GA 30528-1123 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 01/08/2017 |
Last Update Date | 01/08/2017 |