Healthcare Provider Details

I. General information

NPI: 1750023925
Provider Name (Legal Business Name): CARPE DIEM ACADEMY CORPORATION
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/08/2022
Last Update Date: 04/08/2022
Certification Date: 04/08/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3837 S 12TH ST
TACOMA WA
98405-2138
US

IV. Provider business mailing address

3837 S 12TH ST
TACOMA WA
98405-2138
US

V. Phone/Fax

Practice location:
  • Phone: 833-971-1230
  • Fax: 305-971-3095
Mailing address:
  • Phone: 833-971-1230
  • Fax: 305-971-3095

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2251P0200X
TaxonomyPediatric Physical Therapist
License Number
License Number State

VIII. Authorized Official

Name: LISSA TORRES
Title or Position: CEO
Credential:
Phone: 833-971-1230