Provider Demographics
NPI:1518900265
Name:EVERETT, CAROL ANN (PTA, BS)
Entity Type:Individual
Prefix:MRS
First Name:CAROL ANN
Middle Name:
Last Name:EVERETT
Suffix:
Gender:F
Credentials:PTA, BS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:233 HAMPSHIRE LN
Mailing Address - Street 2:
Mailing Address - City:BOLINGBROOK
Mailing Address - State:IL
Mailing Address - Zip Code:60440-1311
Mailing Address - Country:US
Mailing Address - Phone:630-783-8587
Mailing Address - Fax:
Practice Address - Street 1:1200 YORK ROAD
Practice Address - Street 2:ELMHURST HEALTH CARE
Practice Address - City:ELMHURST
Practice Address - State:IL
Practice Address - Zip Code:60126
Practice Address - Country:US
Practice Address - Phone:630-758-8029
Practice Address - Fax:
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-06-13
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant