Provider Demographics
NPI:1316081573
Name:RAUCCI, CARISA MARIA (ATC, LAT)
Entity type:Individual
Prefix:MS
First Name:CARISA
Middle Name:MARIA
Last Name:RAUCCI
Suffix:
Gender:F
Credentials:ATC, LAT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12700 FM 1960 RD W
Mailing Address - Street 2:#14104
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77065-5340
Mailing Address - Country:US
Mailing Address - Phone:210-867-0279
Mailing Address - Fax:
Practice Address - Street 1:7600 SOLOMON ST
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77040-2134
Practice Address - Country:US
Practice Address - Phone:713-896-3432
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-02-19
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXAT31332255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer