Fortenberry, Carrol Shane

Fortenberry, Carrol Shane is an individual health care provider with primary practice located at 2844 Traceland Ave. , Tupelo MS 38801. He recently has only one registered license in Respiratory, Developmental, Rehabilitative and Restorative Service Providers / Physical Therapist, which is considered as his primary health care specialty. Fortenberry, Carrol Shane can be contacted via phone (188) 863-9692.

Contact Information

Primary practice address
2844 Traceland Ave. Tupelo MS 38801
Phone: (188) 863-9692
Fax: (662) 680-5097
Website:
Map and Directions

Health care specialties

SpecialtyCodeLicense #State
Respiratory, Developmental, Rehabilitative and Restorative Service Providers / Physical Therapist 225100000X PT0345 Mississippi
Respiratory, Developmental, Rehabilitative and Restorative Service Providers / Physical Therapist 225100000X PT0000008246 Tennessee

Profile Details

NPI number 1659609923
LBN Legal business name Fortenberry, Carrol Shane
Credentials Physical Therapist (PT)
Entity Individual
Sole proprietor 1 No
Enumeration date Nov 25th, 2009
Last updated Nov 25th, 2009 - about 15 years ago

1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.

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