Provider Demographics
NPI:1306007554
Name:CARLSON, PATRICIA AS (PT)
Entity Type:Individual
Prefix:
First Name:PATRICIA
Middle Name:AS
Last Name:CARLSON
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 867
Mailing Address - Street 2:
Mailing Address - City:YOSEMITE NATIONAL PARK
Mailing Address - State:CA
Mailing Address - Zip Code:95389-0867
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:9000 AHWAHNEE DRIVE
Practice Address - Street 2:
Practice Address - City:YOSEMITE NATIONAL PARK
Practice Address - State:CA
Practice Address - Zip Code:95389-0867
Practice Address - Country:US
Practice Address - Phone:209-372-4637
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-06-20
Last Update Date:2008-06-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPT10916174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist