Provider Demographics
NPI:1942697230
Name:CARUSOTTO, CHRISTIE ROSE (PTA)
Entity Type:Individual
Prefix:
First Name:CHRISTIE
Middle Name:ROSE
Last Name:CARUSOTTO
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 1:1730 SWAMP RD
Mailing Address - Street 2:
Mailing Address - City:RICHMOND
Mailing Address - State:MA
Mailing Address - Zip Code:01254-5162
Mailing Address - Country:US
Mailing Address - Phone:413-358-5997
Mailing Address - Fax:
Practice Address - Street 1:1730 SWAMP RD
Practice Address - Street 2:
Practice Address - City:RICHMOND
Practice Address - State:MA
Practice Address - Zip Code:01254-5162
Practice Address - Country:US
Practice Address - Phone:413-358-5997
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-04-24
Last Update Date:2015-04-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA8546273Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes273Y00000XHospital UnitsRehabilitation Unit