1356419360 NPI number — CARRIE ANN RUBERTINO SHEARER A.T.C, P.T.

Table of content: CARRIE ANN RUBERTINO SHEARER A.T.C, P.T. (NPI 1356419360)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1356419360 NPI number — CARRIE ANN RUBERTINO SHEARER A.T.C, P.T.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
RUBERTINO SHEARER
Provider First Name:
CARRIE
Provider Middle Name:
ANN
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
A.T.C, P.T.
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
RUBERTINO
Provider Other First Name:
CARRIE
Provider Other Middle Name:
ANN
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
A.T.C, P.T.
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1356419360
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
06/01/2010
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
320 EMERGENCY ROOM DR
Provider Second Line Business Mailing Address:
JAMES A. TAYLOR BUILDING CB#7470
Provider Business Mailing Address City Name:
CHAPEL HILL
Provider Business Mailing Address State Name:
NC
Provider Business Mailing Address Postal Code:
27599-7470
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
919-966-6548
Provider Business Mailing Address Fax Number:
919-843-4771

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
320 EMERGENCY ROOM DR
Provider Second Line Business Practice Location Address:
JAMES A. TAYLOR BUILDING CB#7470
Provider Business Practice Location Address City Name:
CHAPEL HILL
Provider Business Practice Location Address State Name:
NC
Provider Business Practice Location Address Postal Code:
27599-7470
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
919-966-6548
Provider Business Practice Location Address Fax Number:
919-843-4771
Provider Enumeration Date:
11/30/2006

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 2251S0007X , with the licence number:  25878 , registered in the state of CA ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 2255A2300X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 2251X0800X , with the licence number: 12302 , registered in the state of NC ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 25878 . This is a "PHYSICAL THERAPY" identifier , issued by the state of ( CA ) . This identifiers is of the category "OTHER".
  • Identifier: 12302 . This is a "PHYSICAL THERAPIST" identifier , issued by the state of ( NC ) . This identifiers is of the category "OTHER".
  • Identifier: 1629 . This is a "LICENSED ATHLETIC TRAINER" identifier , issued by the state of ( NC ) . This identifiers is of the category "OTHER".
  • Identifier: 079802470 . This is a "NATABOC" identifier . This identifiers is of the category "OTHER".