Provider Demographics
NPI:1720103377
Name:CAREY, JERLINE R (PT)
Entity Type:Individual
Prefix:
First Name:JERLINE
Middle Name:R
Last Name:CAREY
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:JERLINE
Other - Middle Name:R
Other - Last Name:HOLTE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PT
Mailing Address - Street 1:10239 LILLEHEI LN SE
Mailing Address - Street 2:
Mailing Address - City:PORT ORCHARD
Mailing Address - State:WA
Mailing Address - Zip Code:98367-9624
Mailing Address - Country:US
Mailing Address - Phone:360-874-3070
Mailing Address - Fax:
Practice Address - Street 1:4459SEMILE HILL DR
Practice Address - Street 2:
Practice Address - City:PORT ORCHARD
Practice Address - State:WA
Practice Address - Zip Code:98366-3908
Practice Address - Country:US
Practice Address - Phone:360-769-5944
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-03-20
Last Update Date:2015-12-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAPT00010078225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist