Provider Demographics
NPI:1740626670
Name:DZIN, CARLIE ANN (ATC, LAT)
Entity type:Individual
Prefix:MRS
First Name:CARLIE
Middle Name:ANN
Last Name:DZIN
Suffix:
Gender:F
Credentials:ATC, LAT
Other - Prefix:MISS
Other - First Name:CARLIE
Other - Middle Name:ANN
Other - Last Name:GOMES
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:ATC, LAT
Mailing Address - Street 1:1555 BOREN DR
Mailing Address - Street 2:
Mailing Address - City:OCOEE
Mailing Address - State:FL
Mailing Address - Zip Code:34761-2989
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:1555 BOREN DR
Practice Address - Street 2:
Practice Address - City:OCOEE
Practice Address - State:FL
Practice Address - Zip Code:34761-2989
Practice Address - Country:US
Practice Address - Phone:407-292-2156
Practice Address - Fax:407-241-2868
Is Sole Proprietor?:No
Enumeration Date:2013-05-19
Last Update Date:2013-05-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLAL29342255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer