Healthcare Provider Details

I. General information

NPI: 1902265903
Provider Name (Legal Business Name): KARY-ANNE CHIARIZIO
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: KARY-ANNE CYR ATC, SCATA

II. Dates (important events)

Enumeration Date: 02/18/2016
Last Update Date: 02/18/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3814 MAYPOP CIR UNIT 203
MYRTLE BEACH SC
29588-1409
US

IV. Provider business mailing address

3814 MAYPOP CIR UNIT 203
MYRTLE BEACH SC
29588-1409
US

V. Phone/Fax

Practice location:
  • Phone: 401-829-3650
  • Fax:
Mailing address:
  • Phone: 401-829-3650
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2255A2300X
TaxonomyAthletic Trainer
License Number1854
License Number StateSC

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: