Provider Demographics
NPI:1124477302
Name:NASRALLAH, CARINA MICHELLE (ATC)
Entity type:Individual
Prefix:MRS
First Name:CARINA
Middle Name:MICHELLE
Last Name:NASRALLAH
Suffix:
Gender:F
Credentials:ATC
Other - Prefix:
Other - First Name:CARINA
Other - Middle Name:MICHELLE
Other - Last Name:STERN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:6445 MAIN ST STE 2500
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77030-1502
Mailing Address - Country:US
Mailing Address - Phone:713-824-4454
Mailing Address - Fax:
Practice Address - Street 1:6445 MAIN ST STE 2500
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77030-1502
Practice Address - Country:US
Practice Address - Phone:713-824-4454
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-06-08
Last Update Date:2017-12-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA01260024522255A2300X
TXAT72682255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer