Healthcare Provider Details

I. General information

NPI: 1619544509
Provider Name (Legal Business Name): CHARLOTTE CARMEL SYLVESTER PT, DPT, ATC, LAT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/08/2021
Last Update Date: 05/27/2022
Certification Date: 05/27/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2498 JOINER CT
DECATUR GA
30033-4912
US

IV. Provider business mailing address

2498 JOINER CT
DECATUR GA
30033-4912
US

V. Phone/Fax

Practice location:
  • Phone: 954-592-3324
  • Fax:
Mailing address:
  • Phone: 954-592-3324
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License NumberPT015910
License Number StateGA
# 2
Primary TaxonomyN
Taxonomy Code2255A2300X
TaxonomyAthletic Trainer
License NumberAT003655
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: