Provider Demographics
NPI:1083970891
Name:CARTER, DICKEY LYNN (PTA)
Entity Type:Individual
Prefix:MR
First Name:DICKEY
Middle Name:LYNN
Last Name:CARTER
Suffix:
Gender:M
Credentials:PTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:801 E MCKEE ST
Mailing Address - Street 2:
Mailing Address - City:GREENEVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37743-6010
Mailing Address - Country:US
Mailing Address - Phone:420-638-9226
Mailing Address - Fax:423-638-1561
Practice Address - Street 1:801 E MCKEE ST
Practice Address - Street 2:
Practice Address - City:GREENEVILLE
Practice Address - State:TN
Practice Address - Zip Code:37743-6010
Practice Address - Country:US
Practice Address - Phone:420-638-9226
Practice Address - Fax:423-638-1561
Is Sole Proprietor?:No
Enumeration Date:2012-04-05
Last Update Date:2012-04-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN0591225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant