Basic Information
| Provider Information | |||||||||
| NPI: | 1760819387 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | CARTAGENA | ||||||||
| FirstName: | SALLY | ||||||||
| MiddleName: | ANN | ||||||||
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| Credential: | RRT | ||||||||
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| Mailing Information | |||||||||
| Address1: | 840 SPARKLEBERRY LN APT 410 | ||||||||
| Address2: | |||||||||
| City: | COLUMBIA | ||||||||
| State: | SC | ||||||||
| PostalCode: | 292296563 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8034574292 | ||||||||
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| Practice Location | |||||||||
| Address1: | 4401 BELLE OAKS DR | ||||||||
| Address2: | SUITE 280 | ||||||||
| City: | N CHARLESTON | ||||||||
| State: | SC | ||||||||
| PostalCode: | 294058537 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8665712700 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 09/27/2013 | ||||||||
| LastUpdateDate: | 09/27/2013 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 227900000X | 460 | SC | Y | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Respiratory Therapist, Registered |
No ID Information.