Basic Information
| Provider Information | |||||||||
| NPI: | 1467116772 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | BECKTON | ||||||||
| FirstName: | CARLA | ||||||||
| MiddleName: | |||||||||
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| Credential: | PT, DPT | ||||||||
| OtherOrganizationName: | |||||||||
| OtherOrganizationType: | |||||||||
| OtherLastName: | ORTIZ ALVAREZ | ||||||||
| OtherFirstName: | CARLA | ||||||||
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| OtherLastNameType: | 1 | ||||||||
| Mailing Information | |||||||||
| Address1: | 336 BROAD ST STE 203 | ||||||||
| Address2: | |||||||||
| City: | ROME | ||||||||
| State: | GA | ||||||||
| PostalCode: | 301613006 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4073800357 | ||||||||
| FaxNumber: | 4073800342 | ||||||||
| Practice Location | |||||||||
| Address1: | 11543 LAKE UNDERHILL RD | ||||||||
| Address2: | |||||||||
| City: | ORLANDO | ||||||||
| State: | FL | ||||||||
| PostalCode: | 328255001 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4073800357 | ||||||||
| FaxNumber: | 4073800342 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 10/25/2021 | ||||||||
| LastUpdateDate: | 06/16/2022 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 06/16/2022 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 225100000X | PT38803 | FL | Y | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Physical Therapist |
No ID Information.