Provider Demographics
NPI:1982902763
Name:DECARIO-WEBBER, KAREN P (PT)
Entity Type:Individual
Prefix:
First Name:KAREN
Middle Name:P
Last Name:DECARIO-WEBBER
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:PO BOX 5545
Mailing Address - Street 2:
Mailing Address - City:AUGUSTA
Mailing Address - State:GA
Mailing Address - Zip Code:30916-5545
Mailing Address - Country:US
Mailing Address - Phone:706-210-9380
Mailing Address - Fax:
Practice Address - Street 1:4274 WASHINGTON RD
Practice Address - Street 2:SUITE 3
Practice Address - City:EVANS
Practice Address - State:GA
Practice Address - Zip Code:30809-3070
Practice Address - Country:US
Practice Address - Phone:706-210-9380
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-03-03
Last Update Date:2011-03-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GAPT008623225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
GAPT008623OtherGA PT LICENSE