Provider Demographics
NPI:1649756610
Name:CHIARENZA, CARLA (PTA)
Entity Type:Individual
Prefix:
First Name:CARLA
Middle Name:
Last Name:CHIARENZA
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 1:8915 HENNEPIN AVE
Mailing Address - Street 2:
Mailing Address - City:NIAGARA FALLS
Mailing Address - State:NY
Mailing Address - Zip Code:14304-4431
Mailing Address - Country:US
Mailing Address - Phone:716-471-3443
Mailing Address - Fax:
Practice Address - Street 1:2295 MILLERSPORT HWY
Practice Address - Street 2:
Practice Address - City:GETZVILLE
Practice Address - State:NY
Practice Address - Zip Code:14068-1399
Practice Address - Country:US
Practice Address - Phone:716-636-5270
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-07-12
Last Update Date:2018-07-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY007178208100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & Rehabilitation