MEDICARE: MS. CARLA MARIE T. GO PT

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	225100000X	Physical Therapist	12411	NC

General Provider Information

NPI Number	:	1356653083
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. CARLA MARIE T. GO PT

Provider Business Mailing Address
First Line	:	4601 PARK RD STE 300
Second Line	:
City	:	CHARLOTTE
State	:	NC
Zip	:	28209-2290
Country	:	US
Telephone Number	:	704-323-2000
Fax Number	:

Provider Business Practice Location Address
First Line	:	197 PIEDMONT BLVD STE 111
Second Line	:
City	:	ROCK HILL
State	:	SC
Zip	:	29732-1825
Country	:	US
Telephone Number	:	704-323-2000
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	07/10/2010
Last Update Date	:	04/02/2018

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Directions to “ MS. CARLA MARIE T. GO PT” Practice Location

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