Individual
CARLA JV BATES
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
DPT
Taxonomy
Speciality
Code
Description
License number
State
225100000X
Physical Therapist
Primary
17888
MA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
000087601
MEDICARE PTAN
MA
01
—
17888
STATE LICENCE
MA
Enumeration date
05/04/2007
Last updated
08/30/2011
Update your record
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