MEDICARE: MRS. LISA ISABELL CARR

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	1744P3200X	Prosthetics Case Management	100734	AL

General Provider Information

NPI Number	:	1730517483
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. LISA ISABELL CARR

Provider Business Mailing Address
First Line	:	3252 UVALDE LN NW
Second Line	:
City	:	HUNTSVILLE
State	:	AL
Zip	:	35810-2932
Country	:	US
Telephone Number	:	256-226-5287
Fax Number	:

Provider Business Practice Location Address
First Line	:	2105 MASTIN LAKE RD NW STE J
Second Line	:
City	:	HUNTSVILLE
State	:	AL
Zip	:	35810-2861
Country	:	US
Telephone Number	:	256-489-2100
Fax Number	:

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

Provider Enumeration Date	:	10/16/2013
Last Update Date	:	10/16/2013

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