Provider Demographics
NPI:1457441172
Name:CARR, JOEY LYNN (PT)
Entity Type:Individual
Prefix:
First Name:JOEY
Middle Name:LYNN
Last Name:CARR
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2637 LAZY BEND ST
Mailing Address - Street 2:SUITE 101
Mailing Address - City:PEARLAND
Mailing Address - State:TX
Mailing Address - Zip Code:77581-1006
Mailing Address - Country:US
Mailing Address - Phone:281-485-4144
Mailing Address - Fax:281-485-4144
Practice Address - Street 1:2637 LAZY BEND ST
Practice Address - Street 2:SUITE 101
Practice Address - City:PEARLAND
Practice Address - State:TX
Practice Address - Zip Code:77581-1006
Practice Address - Country:US
Practice Address - Phone:281-485-4144
Practice Address - Fax:281-485-4144
Is Sole Proprietor?:No
Enumeration Date:2006-10-13
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX1150551225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX8T4680OtherBC/BS
TX2929500OtherAETNA
TX00929TMedicare ID - Type Unspecified