Provider Demographics
NPI:1265627061
Name:MASCARENHAS, CAROLE RUTH (LAC, PTA, LMT)
Entity type:Individual
Prefix:MRS
First Name:CAROLE
Middle Name:RUTH
Last Name:MASCARENHAS
Suffix:
Gender:F
Credentials:LAC, PTA, LMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12268 GRECO DR
Mailing Address - Street 2:
Mailing Address - City:ORLANDO
Mailing Address - State:FL
Mailing Address - Zip Code:32824-5849
Mailing Address - Country:US
Mailing Address - Phone:321-544-9804
Mailing Address - Fax:
Practice Address - Street 1:12268 GRECO DR
Practice Address - Street 2:
Practice Address - City:ORLANDO
Practice Address - State:FL
Practice Address - Zip Code:32824-5849
Practice Address - Country:US
Practice Address - Phone:321-544-9804
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-09-14
Last Update Date:2010-04-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLAP2248171100000X
FLPTA21324225200000X
FLMA32174225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant
No171100000XOther Service ProvidersAcupuncturist
No225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist