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General NPI Number Information
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NPI Number | 1376888685
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Entity Type | Individual
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Provider Name | CARLA ANN MERCER PTA
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Gender | Female
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Dates
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Enumeration Date | 11/28/2012
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Last Update Date | 11/28/2012
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Provider Practice Location Address
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Address Line | 460 SOUTH COLLEGE STREET
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City | WOODBURN
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State | KY
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Zip | 42170-9703
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Country | US
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Telephone | 270-529-2853
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Fax |
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Provider Business Mailing Address
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Address Line | 271 CINDERELLA DR
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City | OWENSBORO
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State | KY
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Zip | 42303-0248
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Country | US
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Telephone | 270-929-1731
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 225200000X
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Taxonomy Name | Physical Therapy Assistant
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License Number | A01536
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License Number State | KY
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Taxonomy #2
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Taxonomy Code | 225200000X
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Taxonomy Name | Physical Therapy Assistant
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License Number | 06003023A
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License Number State | IN
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