Healthcare Provider Details

I. General information

NPI: 1073536538
Provider Name (Legal Business Name): PATRICIA GAYLE CAREY MSPT
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/25/2006
Last Update Date: 09/01/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

19661 CR 18
GOSHEN IN
46528-6217
US

IV. Provider business mailing address

PO BOX 276
SHIPSHEWANA IN
46565-0276
US

V. Phone/Fax

Practice location:
  • Phone: 260-585-4367
  • Fax: 888-835-8511
Mailing address:
  • Phone: 260-585-4367
  • Fax: 888-835-8511

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number070-012668
License Number StateIL
# 2
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number05010107A
License Number StateIN
# 3
Primary TaxonomyN
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number070012668
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: