Carrie M Tedrick, DPT, ATC

Primary specialty

Physical TherapistTaxonomy code 225100000X

Practice address

215 S Grant St
Clinton, IL 61727-1926

Phone

(904) 347-6808

NPI assigned

Aug 9, 2007

Sex

Female

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 3

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1186617600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1186704000000",
    "number": "1053502476",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "215 S GRANT ST",
            "city": "CLINTON",
            "state": "IL",
            "postal_code": "617271926",
            "telephone_number": "904-347-6808"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "215 S GRANT ST",
            "city": "CLINTON",
            "state": "IL",
            "postal_code": "617271926",
            "telephone_number": "904-347-6808"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "TEDRICK",
        "first_name": "CARRIE",
        "middle_name": "M",
        "credential": "DPT, ATC",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2007-08-09",
        "last_updated": "2007-08-10",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "225100000X",
            "taxonomy_group": "",
            "desc": "Physical Therapist",
            "state": "CA",
            "license": "PT 29267",
            "primary": false
        },
        {
            "code": "225100000X",
            "taxonomy_group": "",
            "desc": "Physical Therapist",
            "state": "IL",
            "license": null,
            "primary": true
        },
        {
            "code": "2255A2300X",
            "taxonomy_group": "",
            "desc": "Specialist/Technologist, Athletic Trainer",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Taylor Lynne Spivey
• St. Joseph Medical Center
• Rebecca Stanton, LPC
• Timothy Stead
• Carla Jo Stewart
• Elysa Tripp, MS, CCC-SLP
• Walgreen Co
• Walgreen Co.
• Walmart Inc.
• Shae Michelle Wesley

• Physical Therapist in Clinton, IL
• Providers in Clinton, IL by specialty
• Physical Therapist in Illinois

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 10, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.