Provider Demographics
NPI:1457573982
Name:LEDBETTER, CAROL F
Entity type:Individual
Prefix:MRS
First Name:CAROL
Middle Name:F
Last Name:LEDBETTER
Suffix:
Gender:F
Credentials:
Other - Prefix:MRS
Other - First Name:CAROL
Other - Middle Name:F
Other - Last Name:ERICKSON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PT
Mailing Address - Street 1:106 YOSEMITE CIRCLE
Mailing Address - Street 2:
Mailing Address - City:TUPELO
Mailing Address - State:MS
Mailing Address - Zip Code:38801-4118
Mailing Address - Country:US
Mailing Address - Phone:662-680-3345
Mailing Address - Fax:
Practice Address - Street 1:2800 W MAIN ST
Practice Address - Street 2:
Practice Address - City:TUPELO
Practice Address - State:MS
Practice Address - Zip Code:38801-3027
Practice Address - Country:US
Practice Address - Phone:662-871-7734
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-03
Last Update Date:2011-08-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MSPT3479225100000X
MN838225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MSPT3479OtherPHYSICAL THERAPIST
MN838OtherPHYSICAL THERAPIST