Healthcare Provider Details

I. General information

NPI: 1356419360
Provider Name (Legal Business Name): CARRIE ANN RUBERTINO SHEARER A.T.C, P.T.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: CARRIE ANN RUBERTINO A.T.C, P.T.

II. Dates (important events)

Enumeration Date: 11/30/2006
Last Update Date: 06/01/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

320 EMERGENCY ROOM DR JAMES A. TAYLOR BUILDING CB#7470
CHAPEL HILL NC
27599-7470
US

IV. Provider business mailing address

320 EMERGENCY ROOM DR JAMES A. TAYLOR BUILDING CB#7470
CHAPEL HILL NC
27599-7470
US

V. Phone/Fax

Practice location:
  • Phone: 919-966-6548
  • Fax: 919-843-4771
Mailing address:
  • Phone: 919-966-6548
  • Fax: 919-843-4771

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2251S0007X
TaxonomySports Physical Therapist
License Number25878
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code2255A2300X
TaxonomyAthletic Trainer
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code2251X0800X
TaxonomyOrthopedic Physical Therapist
License Number12302
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: