Provider Demographics
NPI:1538292719
Name:CIAVERELLI, CARRIE (PT)
Entity Type:Individual
Prefix:
First Name:CARRIE
Middle Name:
Last Name:CIAVERELLI
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 1:1927 LOHMAN'S CROSSING
Mailing Address - Street 2:SUITE 100
Mailing Address - City:AUSTIN
Mailing Address - State:TX
Mailing Address - Zip Code:78734-2274
Mailing Address - Country:US
Mailing Address - Phone:512-261-0620
Mailing Address - Fax:512-261-9441
Practice Address - Street 1:1927 LOHMAN'S CROSSING
Practice Address - Street 2:SUITE 100
Practice Address - City:AUSTIN
Practice Address - State:TX
Practice Address - Zip Code:78734-2274
Practice Address - Country:US
Practice Address - Phone:512-261-0620
Practice Address - Fax:512-261-9441
Is Sole Proprietor?:No
Enumeration Date:2007-03-14
Last Update Date:2011-01-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX11491672251P0200X, 225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
No2251P0200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX8T6544OtherBCBS PROVIDER #