Provider Demographics
NPI:1750668653
Name:SENN, CAROLYN HEATHER (PTA)
Entity Type:Individual
Prefix:
First Name:CAROLYN
Middle Name:HEATHER
Last Name:SENN
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 1:9536 CALICO GARDEN AVE
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89134-0165
Mailing Address - Country:US
Mailing Address - Phone:702-807-1305
Mailing Address - Fax:
Practice Address - Street 1:9536 CALICO GARDEN AVE
Practice Address - Street 2:
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89134-0165
Practice Address - Country:US
Practice Address - Phone:702-807-1305
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-11-08
Last Update Date:2011-11-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NVA-0425225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant