Provider Demographics
NPI:1356419360
Name:RUBERTINO SHEARER, CARRIE ANN (ATC, PT)
Entity type:Individual
Prefix:
First Name:CARRIE
Middle Name:ANN
Last Name:RUBERTINO SHEARER
Suffix:
Gender:F
Credentials:ATC, PT
Other - Prefix:
Other - First Name:CARRIE
Other - Middle Name:ANN
Other - Last Name:RUBERTINO
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:ATC, PT
Mailing Address - Street 1:320 EMERGENCY ROOM DR
Mailing Address - Street 2:JAMES A. TAYLOR BUILDING CB#7470
Mailing Address - City:CHAPEL HILL
Mailing Address - State:NC
Mailing Address - Zip Code:27599-7470
Mailing Address - Country:US
Mailing Address - Phone:919-966-6548
Mailing Address - Fax:919-843-4771
Practice Address - Street 1:320 EMERGENCY ROOM DR
Practice Address - Street 2:JAMES A. TAYLOR BUILDING CB#7470
Practice Address - City:CHAPEL HILL
Practice Address - State:NC
Practice Address - Zip Code:27599-7470
Practice Address - Country:US
Practice Address - Phone:919-966-6548
Practice Address - Fax:919-843-4771
Is Sole Proprietor?:No
Enumeration Date:2006-11-30
Last Update Date:2010-06-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA258782251S0007X
2255A2300X
NC123022251X0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2251X0800XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistOrthopedic
No2251S0007XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistSports
No2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA25878OtherPHYSICAL THERAPY
NC12302OtherPHYSICAL THERAPIST
NC1629OtherLICENSED ATHLETIC TRAINER
079802470OtherNATABOC