Provider Demographics
NPI:1043481534
Name:CARTER, LORIELLE SHERIE (DPT, PT)
Entity type:Individual
Prefix:
First Name:LORIELLE
Middle Name:SHERIE
Last Name:CARTER
Suffix:
Gender:F
Credentials:DPT, PT
Other - Prefix:
Other - First Name:LORIELLE
Other - Middle Name:
Other - Last Name:MCQUEEN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DPT
Mailing Address - Street 1:6397 LEE HWY STE 300
Mailing Address - Street 2:
Mailing Address - City:CHATTANOOGA
Mailing Address - State:TN
Mailing Address - Zip Code:37421-4915
Mailing Address - Country:US
Mailing Address - Phone:423-238-7217
Mailing Address - Fax:423-238-3473
Practice Address - Street 1:5370 CAMPBELLTON FAIRBURN RD STE 530
Practice Address - Street 2:
Practice Address - City:FAIRBURN
Practice Address - State:GA
Practice Address - Zip Code:30213-2296
Practice Address - Country:US
Practice Address - Phone:678-666-4146
Practice Address - Fax:678-666-4148
Is Sole Proprietor?:No
Enumeration Date:2008-03-12
Last Update Date:2020-09-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5501013614225100000X
GAPT014074225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist