Provider Demographics
NPI:1871790311
Name:CARTY, JEANETTA L (PTA)
Entity type:Individual
Prefix:
First Name:JEANETTA
Middle Name:L
Last Name:CARTY
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:HC 61 BOX 521
Mailing Address - Street 2:
Mailing Address - City:SALYERSVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:41465-9171
Mailing Address - Country:US
Mailing Address - Phone:606-349-6885
Mailing Address - Fax:
Practice Address - Street 1:571 PARKWAY DR
Practice Address - Street 2:
Practice Address - City:SALYERSVILLE
Practice Address - State:KY
Practice Address - Zip Code:41465-9248
Practice Address - Country:US
Practice Address - Phone:606-349-6181
Practice Address - Fax:606-349-5962
Is Sole Proprietor?:No
Enumeration Date:2007-06-28
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KYA01955225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant