Provider Demographics
NPI:1376793620
Name:CARSON, LAUREN BRITTNEY (PT)
Entity Type:Individual
Prefix:
First Name:LAUREN
Middle Name:BRITTNEY
Last Name:CARSON
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 1:1415 GOOSENECK LN
Mailing Address - Street 2:
Mailing Address - City:CAVE SPRINGS
Mailing Address - State:AR
Mailing Address - Zip Code:72718-5002
Mailing Address - Country:US
Mailing Address - Phone:479-908-6556
Mailing Address - Fax:479-908-6556
Practice Address - Street 1:1000 W POPLAR ST
Practice Address - Street 2:
Practice Address - City:ROGERS
Practice Address - State:AR
Practice Address - Zip Code:72756-4242
Practice Address - Country:US
Practice Address - Phone:479-631-7678
Practice Address - Fax:479-631-8886
Is Sole Proprietor?:No
Enumeration Date:2008-09-23
Last Update Date:2014-09-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ARPT 3087225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
AR175204721Medicaid
ARP00671333OtherMEDICARE RAILROAD
ARP00671333OtherMEDICARE RAILROAD