Provider Demographics
NPI:1508026311
Name:KELLY, CARLA FISHER (PT)
Entity Type:Individual
Prefix:MRS
First Name:CARLA
Middle Name:FISHER
Last Name:KELLY
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 1:104 OAK ALY
Mailing Address - Street 2:
Mailing Address - City:MANDEVILLE
Mailing Address - State:LA
Mailing Address - Zip Code:70471-3062
Mailing Address - Country:US
Mailing Address - Phone:251-510-4016
Mailing Address - Fax:
Practice Address - Street 1:104 OAK ALY
Practice Address - Street 2:
Practice Address - City:MANDEVILLE
Practice Address - State:LA
Practice Address - Zip Code:70471-3062
Practice Address - Country:US
Practice Address - Phone:251-510-4016
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-06-15
Last Update Date:2012-01-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA037232251P0200X
ALPTH45432251P0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2251P0200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistPediatrics