Provider Demographics
NPI:1366549743
Name:MINAHAN, CARRIE ANN (PT,NCS)
Entity type:Individual
Prefix:MS
First Name:CARRIE
Middle Name:ANN
Last Name:MINAHAN
Suffix:
Gender:F
Credentials:PT,NCS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:290 FIRST ST
Mailing Address - Street 2:
Mailing Address - City:PITTSFIELD
Mailing Address - State:MA
Mailing Address - Zip Code:01201
Mailing Address - Country:US
Mailing Address - Phone:413-443-4246
Mailing Address - Fax:413-443-0737
Practice Address - Street 1:290 FIRST ST
Practice Address - Street 2:
Practice Address - City:PITTSFIELD
Practice Address - State:MA
Practice Address - Zip Code:01201
Practice Address - Country:US
Practice Address - Phone:413-443-4246
Practice Address - Fax:413-443-0737
Is Sole Proprietor?:No
Enumeration Date:2006-09-20
Last Update Date:2008-12-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
RIPTO1679225100000X
MA9968225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA9759441Medicaid
MA9759441Medicaid
MAPT0003Medicare UPIN