Provider Demographics
NPI:1588129118
Name:STOTE, CARLY ANN (PT, DPT)
Entity type:Individual
Prefix:
First Name:CARLY
Middle Name:ANN
Last Name:STOTE
Suffix:
Gender:F
Credentials:PT, DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:122 TUDOR ST
Mailing Address - Street 2:
Mailing Address - City:BOSTON
Mailing Address - State:MA
Mailing Address - Zip Code:02127-2682
Mailing Address - Country:US
Mailing Address - Phone:845-594-2778
Mailing Address - Fax:
Practice Address - Street 1:133 FEDERAL ST
Practice Address - Street 2:
Practice Address - City:BOSTON
Practice Address - State:MA
Practice Address - Zip Code:02110-1703
Practice Address - Country:US
Practice Address - Phone:617-247-2300
Practice Address - Fax:617-936-4196
Is Sole Proprietor?:Yes
Enumeration Date:2019-02-07
Last Update Date:2019-02-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA24127225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist