Provider Demographics
NPI:1437738127
Name:PIAZZA, CARRIE (PTA)
Entity Type:Individual
Prefix:
First Name:CARRIE
Middle Name:
Last Name:PIAZZA
Suffix:
Gender:F
Credentials:PTA
Other - Prefix:
Other - First Name:CARRIE
Other - Middle Name:
Other - Last Name:WILLIAMS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:26610 277TH AVE
Mailing Address - Street 2:
Mailing Address - City:PRINCETON
Mailing Address - State:IA
Mailing Address - Zip Code:52768-9743
Mailing Address - Country:US
Mailing Address - Phone:563-505-0355
Mailing Address - Fax:
Practice Address - Street 1:1455 HOSPITAL RD
Practice Address - Street 2:
Practice Address - City:SILVIS
Practice Address - State:IL
Practice Address - Zip Code:61282-1834
Practice Address - Country:US
Practice Address - Phone:309-865-7132
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-04-07
Last Update Date:2021-04-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL160003719225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant