Provider Demographics
NPI:1447380936
Name:CARSWELL, LATRENDA H (PT ASST)
Entity Type:Individual
Prefix:
First Name:LATRENDA
Middle Name:H
Last Name:CARSWELL
Suffix:
Gender:F
Credentials:PT ASST
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:115 CHICOPEE MEWS
Mailing Address - Street 2:
Mailing Address - City:CAMILLUS
Mailing Address - State:NY
Mailing Address - Zip Code:13031-2075
Mailing Address - Country:US
Mailing Address - Phone:315-478-0463
Mailing Address - Fax:315-476-9757
Practice Address - Street 1:800 S WILBUR AVE
Practice Address - Street 2:
Practice Address - City:SYRACUSE
Practice Address - State:NY
Practice Address - Zip Code:13204-2732
Practice Address - Country:US
Practice Address - Phone:315-478-0463
Practice Address - Fax:315-476-9757
Is Sole Proprietor?:No
Enumeration Date:2007-03-06
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY005125-1225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant