Provider Demographics
NPI:1962969600
Name:TREVIZO, CARLA (PTA)
Entity type:Individual
Prefix:
First Name:CARLA
Middle Name:
Last Name:TREVIZO
Suffix:
Gender:F
Credentials:PTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10700 CHARTER DR STE 205
Mailing Address - Street 2:
Mailing Address - City:COLUMBIA
Mailing Address - State:MD
Mailing Address - Zip Code:21044-3687
Mailing Address - Country:US
Mailing Address - Phone:443-546-1575
Mailing Address - Fax:443-546-1576
Practice Address - Street 1:10700 CHARTER DR STE 205
Practice Address - Street 2:
Practice Address - City:COLUMBIA
Practice Address - State:MD
Practice Address - Zip Code:21044-3687
Practice Address - Country:US
Practice Address - Phone:443-546-1575
Practice Address - Fax:443-546-1576
Is Sole Proprietor?:No
Enumeration Date:2019-03-01
Last Update Date:2019-03-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant