Healthcare Provider Details

I. General information

NPI: 1720903883
Provider Name (Legal Business Name): CARLY RAE BINES
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/10/2026
Last Update Date: 08/10/2026
Certification Date: 08/10/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9079 BELCHER RD N
PINELLAS PARK FL
33782-4423
US

IV. Provider business mailing address

9079 BELCHER RD N FL 33782
PINELLAS PARK FL
33782-4423
US

V. Phone/Fax

Practice location:
  • Phone: 727-616-0809
  • Fax:
Mailing address:
  • Phone: 727-616-0809
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License NumberPT45142
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: