Provider Demographics
NPI:1104018639
Name:ALBERT, CARLA R (PT)
Entity Type:Individual
Prefix:
First Name:CARLA
Middle Name:R
Last Name:ALBERT
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 1260
Mailing Address - Street 2:
Mailing Address - City:CORVALLIS
Mailing Address - State:MT
Mailing Address - Zip Code:59828
Mailing Address - Country:US
Mailing Address - Phone:406-961-3841
Mailing Address - Fax:406-961-6814
Practice Address - Street 1:1016 BROOKS AVE
Practice Address - Street 2:
Practice Address - City:CORVALLIS
Practice Address - State:MT
Practice Address - Zip Code:59828
Practice Address - Country:US
Practice Address - Phone:406-961-3841
Practice Address - Fax:406-961-6814
Is Sole Proprietor?:No
Enumeration Date:2007-08-17
Last Update Date:2016-11-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MT716225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MT0036309Medicaid
MT0000600330OtherBCBS
MT0000600330OtherBCBS