Provider Demographics
NPI:1194087213
Name:CARLBERT, AMBER (DPT)
Entity type:Individual
Prefix:
First Name:AMBER
Middle Name:
Last Name:CARLBERT
Suffix:
Gender:F
Credentials:DPT
Other - Prefix:
Other - First Name:AMBER
Other - Middle Name:
Other - Last Name:MANVILLE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:760 MAIN ST S
Mailing Address - Street 2:
Mailing Address - City:SOUTHBURY
Mailing Address - State:CT
Mailing Address - Zip Code:06488-4248
Mailing Address - Country:US
Mailing Address - Phone:203-437-6155
Mailing Address - Fax:
Practice Address - Street 1:760 MAIN ST S STE D
Practice Address - Street 2:
Practice Address - City:SOUTHBURY
Practice Address - State:CT
Practice Address - Zip Code:06488-4248
Practice Address - Country:US
Practice Address - Phone:203-437-6155
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-06-14
Last Update Date:2024-01-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT1234225200000X
CT012131225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
No225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
CT004190328Medicaid
CT004190328Medicaid