Provider Demographics
NPI:1093380297
Name:PRATT, CARRIE (LAC, DIPLAC)
Entity Type:Individual
Prefix:
First Name:CARRIE
Middle Name:
Last Name:PRATT
Suffix:
Gender:F
Credentials:LAC, DIPLAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:755 WEST LANCASTER AVE
Mailing Address - Street 2:#1005
Mailing Address - City:BRYN MAWR
Mailing Address - State:PA
Mailing Address - Zip Code:19010
Mailing Address - Country:US
Mailing Address - Phone:484-367-5336
Mailing Address - Fax:
Practice Address - Street 1:564 MAPLEWOOD AVE
Practice Address - Street 2:
Practice Address - City:WAYNE
Practice Address - State:PA
Practice Address - Zip Code:19087
Practice Address - Country:US
Practice Address - Phone:484-367-5336
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-05-21
Last Update Date:2021-05-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAAK001097171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist