Provider Demographics
NPI:1558131771
Name:CARTER, RACHEL SHEA (PTA)
Entity Type:Individual
Prefix:MRS
First Name:RACHEL
Middle Name:SHEA
Last Name:CARTER
Suffix:
Gender:F
Credentials:PTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5554 KAITLYN DR E
Mailing Address - Street 2:
Mailing Address - City:WALLS
Mailing Address - State:MS
Mailing Address - Zip Code:38680-8535
Mailing Address - Country:US
Mailing Address - Phone:901-831-2271
Mailing Address - Fax:
Practice Address - Street 1:391 SOUTHCREST CIR STE 205
Practice Address - Street 2:
Practice Address - City:SOUTHAVEN
Practice Address - State:MS
Practice Address - Zip Code:38671-6729
Practice Address - Country:US
Practice Address - Phone:901-260-6117
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-01-08
Last Update Date:2024-01-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MSPTA-7670225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant