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

Table of content: MARISSA B SHENNAN LMFT (NPI 1952857435)

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".