Provider Demographics
NPI:1821296708
Name:TINGLEY, CARL MALCOLM (PTA)
Entity Type:Individual
Prefix:MR
First Name:CARL
Middle Name:MALCOLM
Last Name:TINGLEY
Suffix:
Gender:M
Credentials:PTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:342 MCSHEFFERY ROAD
Mailing Address - Street 2:
Mailing Address - City:HOULTON
Mailing Address - State:ME
Mailing Address - Zip Code:04730
Mailing Address - Country:US
Mailing Address - Phone:207-532-2527
Mailing Address - Fax:
Practice Address - Street 1:342 MCSHEFFERY ROAD
Practice Address - Street 2:
Practice Address - City:HOULTON
Practice Address - State:ME
Practice Address - Zip Code:04730
Practice Address - Country:US
Practice Address - Phone:207-532-2527
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-07-03
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MEPA1736225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant