Provider Demographics
NPI:1811015696
Name:CARBONE, CAROL A (LMT)
Entity Type:Individual
Prefix:MS
First Name:CAROL
Middle Name:A
Last Name:CARBONE
Suffix:
Gender:F
Credentials:LMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:1334 TIMBERLANE RD
Mailing Address - Street 2:SUITE 4
Mailing Address - City:TALLAHASSEE
Mailing Address - State:FL
Mailing Address - Zip Code:32312-1766
Mailing Address - Country:US
Mailing Address - Phone:850-668-0508
Mailing Address - Fax:850-907-8245
Practice Address - Street 1:1334 TIMBERLANE RD
Practice Address - Street 2:SUITE 4
Practice Address - City:TALLAHASSEE
Practice Address - State:FL
Practice Address - Zip Code:32312-1766
Practice Address - Country:US
Practice Address - Phone:850-668-0508
Practice Address - Fax:850-907-8245
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-27
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLMA 29024225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist