Provider Demographics
NPI:1790190106
Name:CARLEY, PATRICK (PT)
Entity Type:Individual
Prefix:PROF
First Name:PATRICK
Middle Name:
Last Name:CARLEY
Suffix:
Gender:M
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:207 MUNGER HILL RD
Mailing Address - Street 2:
Mailing Address - City:WESTFIELD
Mailing Address - State:MA
Mailing Address - Zip Code:01085-4591
Mailing Address - Country:US
Mailing Address - Phone:413-205-3294
Mailing Address - Fax:413-568-8728
Practice Address - Street 1:207 MUNGER HILL RD
Practice Address - Street 2:
Practice Address - City:WESTFIELD
Practice Address - State:MA
Practice Address - Zip Code:01085-4591
Practice Address - Country:US
Practice Address - Phone:413-205-3294
Practice Address - Fax:413-568-8728
Is Sole Proprietor?:Yes
Enumeration Date:2014-06-24
Last Update Date:2014-06-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA35182251E1200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2251E1200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistErgonomics
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA02061956Medicaid