Provider Demographics
NPI:1336462225
Name:CARTER, EDWARD ALLEN (DPT)
Entity Type:Individual
Prefix:
First Name:EDWARD
Middle Name:ALLEN
Last Name:CARTER
Suffix:
Gender:M
Credentials:DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4715 N 32ND ST
Mailing Address - Street 2:SUITE 108
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85018-3300
Mailing Address - Country:US
Mailing Address - Phone:480-689-5520
Mailing Address - Fax:480-706-7409
Practice Address - Street 1:2222 E HIGHLAND AVE
Practice Address - Street 2:SUITE 200
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85016-4872
Practice Address - Country:US
Practice Address - Phone:602-595-6180
Practice Address - Fax:602-595-7659
Is Sole Proprietor?:Yes
Enumeration Date:2010-03-05
Last Update Date:2014-03-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ10733225100000X
2251X0800X, 2251S0007X
CAPT361622251X0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
No2251X0800XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistOrthopedic
No2251S0007XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistSports
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAPT36162OtherLICENSE