Provider Demographics
NPI:1245529288
Name:AHLERS, CARISSA (PT)
Entity type:Individual
Prefix:MRS
First Name:CARISSA
Middle Name:
Last Name:AHLERS
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10570 136TH ST
Mailing Address - Street 2:
Mailing Address - City:LARGO
Mailing Address - State:FL
Mailing Address - Zip Code:33774-5431
Mailing Address - Country:US
Mailing Address - Phone:727-804-9659
Mailing Address - Fax:727-517-2123
Practice Address - Street 1:10570 136TH ST
Practice Address - Street 2:
Practice Address - City:LARGO
Practice Address - State:FL
Practice Address - Zip Code:33774-5431
Practice Address - Country:US
Practice Address - Phone:727-804-9659
Practice Address - Fax:727-517-2123
Is Sole Proprietor?:Yes
Enumeration Date:2011-03-30
Last Update Date:2011-03-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPT16609225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist