Provider Demographics
NPI:1750626065
Name:RANSEY, CARLOS DEVAUGHN (PTA)
Entity type:Individual
Prefix:
First Name:CARLOS
Middle Name:DEVAUGHN
Last Name:RANSEY
Suffix:
Gender:M
Credentials:PTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:821 WRATHER RD
Mailing Address - Street 2:
Mailing Address - City:ALMO
Mailing Address - State:KY
Mailing Address - Zip Code:42020-9222
Mailing Address - Country:US
Mailing Address - Phone:270-978-1887
Mailing Address - Fax:
Practice Address - Street 1:716 POPLAR ST
Practice Address - Street 2:
Practice Address - City:MURRAY
Practice Address - State:KY
Practice Address - Zip Code:42071-2546
Practice Address - Country:US
Practice Address - Phone:270-762-1854
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-11-28
Last Update Date:2012-11-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KYA02483225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant