Provider Demographics
NPI:1073536538
Name:CAREY, PATRICIA GAYLE (MSPT)
Entity Type:Individual
Prefix:
First Name:PATRICIA
Middle Name:GAYLE
Last Name:CAREY
Suffix:
Gender:F
Credentials:MSPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 276
Mailing Address - Street 2:
Mailing Address - City:SHIPSHEWANA
Mailing Address - State:IN
Mailing Address - Zip Code:46565-0276
Mailing Address - Country:US
Mailing Address - Phone:260-585-4367
Mailing Address - Fax:888-835-8511
Practice Address - Street 1:19661 CR 18
Practice Address - Street 2:
Practice Address - City:GOSHEN
Practice Address - State:IN
Practice Address - Zip Code:46528-6217
Practice Address - Country:US
Practice Address - Phone:260-585-4367
Practice Address - Fax:888-835-8511
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-25
Last Update Date:2010-09-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL070-012668225100000X
IN05010107A225100000X
IL070012668225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL0006032133OtherBCBSIL PROVIDER NUMBER