Provider Demographics
NPI:1235244658
Name:CARL, TIA R (PT)
Entity Type:Individual
Prefix:
First Name:TIA
Middle Name:R
Last Name:CARL
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:4750 LINDLE ROAD
Mailing Address - Street 2:SUITE 100
Mailing Address - City:HARRISBURG
Mailing Address - State:PA
Mailing Address - Zip Code:17111-2428
Mailing Address - Country:US
Mailing Address - Phone:717-803-3342
Mailing Address - Fax:717-974-8743
Practice Address - Street 1:558 SHREWSBURY COMMONS AVE
Practice Address - Street 2:
Practice Address - City:SHREWSBURY
Practice Address - State:PA
Practice Address - Zip Code:17361-1615
Practice Address - Country:US
Practice Address - Phone:717-803-3344
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-08-19
Last Update Date:2024-03-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAPT031739225100000X
MD21940225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD468MS955Medicare Oscar/Certification