Provider Demographics
NPI:1225655798
Name:CARRICATO, MARYANN (LMT)
Entity Type:Individual
Prefix:
First Name:MARYANN
Middle Name:
Last Name:CARRICATO
Suffix:
Gender:F
Credentials:LMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:213 COOPER ST
Mailing Address - Street 2:
Mailing Address - City:MANCHESTER
Mailing Address - State:PA
Mailing Address - Zip Code:17345-1415
Mailing Address - Country:US
Mailing Address - Phone:717-845-4567
Mailing Address - Fax:
Practice Address - Street 1:804 LOUCKS RD
Practice Address - Street 2:
Practice Address - City:YORK
Practice Address - State:PA
Practice Address - Zip Code:17404-1928
Practice Address - Country:US
Practice Address - Phone:717-845-4567
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-07-01
Last Update Date:2020-07-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMSG005401225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage TherapistGroup - Single Specialty