MEDICARE: MISS TELLA CARTER

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	208100000X	Physical Medicine & Rehabilitation Physician	110987	IN

General Provider Information

NPI Number	:	1659263036
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MISS TELLA CARTER

Provider Business Mailing Address
First Line	:	822 W DEWALD ST
Second Line	:
City	:	FORT WAYNE
State	:	IN
Zip	:	46802-5171
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	4329 REED ST
Second Line	:
City	:	FORT WAYNE
State	:	IN
Zip	:	46806-4825
Country	:	US
Telephone Number	:	260-237-5950
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	07/18/2025
Last Update Date	:	07/18/2025

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Directions to “ MISS TELLA CARTER ” Practice Location

Language	Start Address	Practice Location

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