Provider Demographics
NPI:1467667964
Name:PIERCE, CAROL WAKEFIELD (PT)
Entity type:Individual
Prefix:MRS
First Name:CAROL
Middle Name:WAKEFIELD
Last Name:PIERCE
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6 SEAWARD CIR.
Mailing Address - Street 2:
Mailing Address - City:ENGLEWOOD
Mailing Address - State:FL
Mailing Address - Zip Code:33946
Mailing Address - Country:US
Mailing Address - Phone:941-698-4078
Mailing Address - Fax:941-698-4079
Practice Address - Street 1:400 S INDIANA AVE
Practice Address - Street 2:
Practice Address - City:ENGLEWOOD
Practice Address - State:FL
Practice Address - Zip Code:34223-3752
Practice Address - Country:US
Practice Address - Phone:941-474-0419
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-05-10
Last Update Date:2013-09-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL225100000X225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLPT12477OtherSTATE LICENSE NUMBWER