Provider Demographics
NPI:1316286990
Name:CARTER, LAVIETTE T
Entity type:Individual
Prefix:MR
First Name:LAVIETTE
Middle Name:T
Last Name:CARTER
Suffix:
Gender:M
Credentials:
Other - Prefix:MR
Other - First Name:LAVIETTE
Other - Middle Name:T
Other - Last Name:CARTER
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:
Mailing Address - Street 1:80 TILLMAN ST STE 108
Mailing Address - Street 2:
Mailing Address - City:MEMPHIS
Mailing Address - State:TN
Mailing Address - Zip Code:38111-2727
Mailing Address - Country:US
Mailing Address - Phone:901-907-0154
Mailing Address - Fax:901-907-0214
Practice Address - Street 1:80 TILLMAN ST STE 108
Practice Address - Street 2:
Practice Address - City:MEMPHIS
Practice Address - State:TN
Practice Address - Zip Code:38111-2727
Practice Address - Country:US
Practice Address - Phone:901-907-0154
Practice Address - Fax:901-907-0154
Is Sole Proprietor?:Yes
Enumeration Date:2013-02-02
Last Update Date:2013-02-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN225400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225400000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersRehabilitation Practitioner