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NPI Code Detail

MEDICARE: ALICE CARBALLO

MEDICARE: ALICE CARBALLO
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
1225100000XPhysical Therapist05230LA

General Provider Information

NPI Number : 1427413152
Entity Type Code : Individual
Provider Name (Legal Business Name) : ALICE CARBALLO
Provider Business Mailing Address
First Line : 19469 PAR LN
Second Line :
City : HAMMOND
State : LA
Zip : 70401-8242
Country : US
Telephone Number : 504-458-8896
Fax Number :
Provider Business Practice Location Address
First Line : 709 E NORTH PL
Second Line :
City : AMITE
State : LA
Zip : 70422-2307
Country : US
Telephone Number : 985-748-9464
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 12/22/2015
Last Update Date : 12/22/2015

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Directions to “ ALICE CARBALLO ” Practice Location

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