Provider Demographics
NPI:1003837584
Name:CARLSON, JAMES CRAIG (ATC, LAT)
Entity Type:Individual
Prefix:
First Name:JAMES
Middle Name:CRAIG
Last Name:CARLSON
Suffix:
Gender:M
Credentials:ATC, LAT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7045 TOBOSA AVE
Mailing Address - Street 2:
Mailing Address - City:ODESSA
Mailing Address - State:TX
Mailing Address - Zip Code:79765-3102
Mailing Address - Country:US
Mailing Address - Phone:432-366-7311
Mailing Address - Fax:
Practice Address - Street 1:2525 N GRANDVIEW AVE STE 400
Practice Address - Street 2:
Practice Address - City:ODESSA
Practice Address - State:TX
Practice Address - Zip Code:79761-1600
Practice Address - Country:US
Practice Address - Phone:432-550-4700
Practice Address - Fax:432-550-4715
Is Sole Proprietor?:No
Enumeration Date:2006-07-21
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXAT07912255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer