Provider Demographics
NPI:1285663690
Name:CARR, LADAWN WOLFE (PTA/ ATC)
Entity Type:Individual
Prefix:
First Name:LADAWN
Middle Name:WOLFE
Last Name:CARR
Suffix:
Gender:F
Credentials:PTA/ ATC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5302 VILLA RD
Mailing Address - Street 2:
Mailing Address - City:KNOXVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37918-3660
Mailing Address - Country:US
Mailing Address - Phone:865-573-6458
Mailing Address - Fax:865-577-8147
Practice Address - Street 1:4011 CHAPMAN HWY
Practice Address - Street 2:
Practice Address - City:KNOXVILLE
Practice Address - State:TN
Practice Address - Zip Code:37920-4267
Practice Address - Country:US
Practice Address - Phone:865-573-6458
Practice Address - Fax:865-577-8147
Is Sole Proprietor?:No
Enumeration Date:2006-06-30
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN2919225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant