Provider Demographics
NPI:1063634608
Name:CARTER, MICHELLE A (PT, DPT)
Entity Type:Individual
Prefix:DR
First Name:MICHELLE
Middle Name:A
Last Name:CARTER
Suffix:
Gender:F
Credentials:PT, DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6303 S 26TH ST
Mailing Address - Street 2:
Mailing Address - City:ROGERS
Mailing Address - State:AR
Mailing Address - Zip Code:72758-4524
Mailing Address - Country:US
Mailing Address - Phone:501-454-1040
Mailing Address - Fax:479-222-0048
Practice Address - Street 1:6303 S 26TH ST
Practice Address - Street 2:
Practice Address - City:ROGERS
Practice Address - State:AR
Practice Address - Zip Code:72758-4524
Practice Address - Country:US
Practice Address - Phone:501-454-1040
Practice Address - Fax:479-222-0048
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-03
Last Update Date:2016-11-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ARPT26952251P0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2251P0200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
AR5V700OtherBLUE CROSS AND BLUE SHIELD
AR12351026OtherCAQH PROVIDER ID
AR150403721Medicaid