Provider Demographics
NPI:1548293996
Name:FABELLA, CARRIE ELEANOR (RPT)
Entity type:Individual
Prefix:MRS
First Name:CARRIE
Middle Name:ELEANOR
Last Name:FABELLA
Suffix:
Gender:F
Credentials:RPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12421 CENTRAL AVE
Mailing Address - Street 2:SUITE A & B
Mailing Address - City:CHINO
Mailing Address - State:CA
Mailing Address - Zip Code:91710
Mailing Address - Country:US
Mailing Address - Phone:909-628-9612
Mailing Address - Fax:909-591-9942
Practice Address - Street 1:12421 CENTRAL AVE
Practice Address - Street 2:SUITE A & B
Practice Address - City:CHINO
Practice Address - State:CA
Practice Address - Zip Code:91710
Practice Address - Country:US
Practice Address - Phone:909-628-9612
Practice Address - Fax:909-591-9942
Is Sole Proprietor?:No
Enumeration Date:2006-07-09
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPT14577225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAOPT145770Medicare ID - Type Unspecified