Healthcare Provider Details

I. General information

NPI: 1730517483
Provider Name (Legal Business Name): MRS. LISA ISABELL CARR
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/16/2013
Last Update Date: 10/16/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2105 MASTIN LAKE RD NW STE J
HUNTSVILLE AL
35810-2861
US

IV. Provider business mailing address

3252 UVALDE LN NW
HUNTSVILLE AL
35810-2932
US

V. Phone/Fax

Practice location:
  • Phone: 256-489-2100
  • Fax:
Mailing address:
  • Phone: 256-226-5287
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1744P3200X
TaxonomyProsthetics Case Management
License Number100734
License Number StateAL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: