Provider Demographics
NPI:1396010542
Name:CHERIAN, CARRIE KM (PTA)
Entity Type:Individual
Prefix:MRS
First Name:CARRIE
Middle Name:KM
Last Name:CHERIAN
Suffix:
Gender:F
Credentials:PTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:15627 W SHANGRI LA RD
Mailing Address - Street 2:
Mailing Address - City:SURPRISE
Mailing Address - State:AZ
Mailing Address - Zip Code:85379-4797
Mailing Address - Country:US
Mailing Address - Phone:623-584-9778
Mailing Address - Fax:
Practice Address - Street 1:14260 S DENNY BLVD
Practice Address - Street 2:
Practice Address - City:LITCHFIELD PARK
Practice Address - State:AZ
Practice Address - Zip Code:85340-9448
Practice Address - Country:US
Practice Address - Phone:623-537-7400
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-03-20
Last Update Date:2012-03-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ9585A225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant