Provider Demographics
NPI:1649766528
Name:DENDTLER, CARRIE ELIZABETH (PT)
Entity Type:Individual
Prefix:
First Name:CARRIE
Middle Name:ELIZABETH
Last Name:DENDTLER
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:CARRIE
Other - Middle Name:ELIZABETH
Other - Last Name:SAWYER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:320 MONTGOMERY AVE
Mailing Address - Street 2:
Mailing Address - City:ALPHARETTA
Mailing Address - State:GA
Mailing Address - Zip Code:30004-3163
Mailing Address - Country:US
Mailing Address - Phone:678-767-2889
Mailing Address - Fax:
Practice Address - Street 1:320 MONTGOMERY AVE
Practice Address - Street 2:
Practice Address - City:ALPHARETTA
Practice Address - State:GA
Practice Address - Zip Code:30004-3163
Practice Address - Country:US
Practice Address - Phone:678-767-2889
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-07-03
Last Update Date:2020-02-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA0059592251X0800X
GALC000165174N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2251X0800XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistOrthopedic
No174N00000XOther Service ProvidersLactation Consultant, Non-RN