Provider Demographics
NPI:1548054554
Name:CARRIL, CARLY BLEEM (DPT)
Entity type:Individual
Prefix:DR
First Name:CARLY
Middle Name:BLEEM
Last Name:CARRIL
Suffix:
Gender:
Credentials:DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2239 PALESTRA DR APT 21
Mailing Address - Street 2:
Mailing Address - City:SAINT LOUIS
Mailing Address - State:MO
Mailing Address - Zip Code:63146-2643
Mailing Address - Country:US
Mailing Address - Phone:618-977-6452
Mailing Address - Fax:
Practice Address - Street 1:1475 KISKER RD STE 150
Practice Address - Street 2:
Practice Address - City:SAINT CHARLES
Practice Address - State:MO
Practice Address - Zip Code:63304-8789
Practice Address - Country:US
Practice Address - Phone:636-498-7474
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-04-07
Last Update Date:2025-04-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2025007301225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist