Provider Demographics
NPI:1902563422
Name:MUELLER, CARLA (PTA)
Entity Type:Individual
Prefix:
First Name:CARLA
Middle Name:
Last Name:MUELLER
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 1:1765 RED CEDAR DR APT 2
Mailing Address - Street 2:
Mailing Address - City:FORT MYERS
Mailing Address - State:FL
Mailing Address - Zip Code:33907-7641
Mailing Address - Country:US
Mailing Address - Phone:561-345-5889
Mailing Address - Fax:
Practice Address - Street 1:1765 RED CEDAR DR APT 2
Practice Address - Street 2:
Practice Address - City:FORT MYERS
Practice Address - State:FL
Practice Address - Zip Code:33907-7641
Practice Address - Country:US
Practice Address - Phone:561-345-5889
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-11-18
Last Update Date:2021-11-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant