Provider Demographics
NPI:1417195975
Name:VARISANO, CARLA ASSUNTA (PTA)
Entity Type:Individual
Prefix:MS
First Name:CARLA
Middle Name:ASSUNTA
Last Name:VARISANO
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 1:835 PEQUASH AVE
Mailing Address - Street 2:
Mailing Address - City:CUTCHOGUE
Mailing Address - State:NY
Mailing Address - Zip Code:11935-1426
Mailing Address - Country:US
Mailing Address - Phone:631-734-7128
Mailing Address - Fax:
Practice Address - Street 1:835 PEQUASH AVE
Practice Address - Street 2:
Practice Address - City:CUTCHOGUE
Practice Address - State:NY
Practice Address - Zip Code:11935-1426
Practice Address - Country:US
Practice Address - Phone:631-734-7128
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-01-21
Last Update Date:2009-01-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY004512-1225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant