MEDICARE: JAMIE CARTER PTA

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	225200000X	Physical Therapy Assistant	19779	FL

General Provider Information

NPI Number	:	1689871550
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JAMIE CARTER PTA

Provider Business Mailing Address
First Line	:	11738 RAINDROP RD
Second Line	:
City	:	JACKSONVILLE
State	:	FL
Zip	:	32219-5158
Country	:	US
Telephone Number	:	850-321-1092
Fax Number	:

Provider Business Practice Location Address
First Line	:	11738 RAINDROP RD
Second Line	:
City	:	JACKSONVILLE
State	:	FL
Zip	:	32219-5158
Country	:	US
Telephone Number	:	850-321-1092
Fax Number	:

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

Provider Enumeration Date	:	07/02/2007
Last Update Date	:	07/08/2007

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