Provider Demographics
NPI:1568889889
Name:ELLER, CARRIE (LMT, CMT)
Entity Type:Individual
Prefix:
First Name:CARRIE
Middle Name:
Last Name:ELLER
Suffix:
Gender:F
Credentials:LMT, CMT
Other - Prefix:
Other - First Name:CARRIE
Other - Middle Name:
Other - Last Name:ELLER-ARMSTRONG
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:LMT, CMT
Mailing Address - Street 1:52 ALBERTA AVE
Mailing Address - Street 2:
Mailing Address - City:WHEELING
Mailing Address - State:WV
Mailing Address - Zip Code:26003-5213
Mailing Address - Country:US
Mailing Address - Phone:304-280-0127
Mailing Address - Fax:
Practice Address - Street 1:52 ALBERTA AVE
Practice Address - Street 2:
Practice Address - City:WHEELING
Practice Address - State:WV
Practice Address - Zip Code:26003-5213
Practice Address - Country:US
Practice Address - Phone:304-280-0127
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-03-25
Last Update Date:2014-03-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WV2003-1302225700000X
VA0019010495225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist