Provider Demographics
NPI:1508102377
Name:CARSTENS, JOHN WARREN (PTA)
Entity Type:Individual
Prefix:MR
First Name:JOHN
Middle Name:WARREN
Last Name:CARSTENS
Suffix:
Gender:M
Credentials:PTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8113 E SUNFLOWER CT
Mailing Address - Street 2:
Mailing Address - City:SPOKANE
Mailing Address - State:WA
Mailing Address - Zip Code:99217-9505
Mailing Address - Country:US
Mailing Address - Phone:509-225-0552
Mailing Address - Fax:
Practice Address - Street 1:6025 N ASSEMBLY ST
Practice Address - Street 2:
Practice Address - City:SPOKANE
Practice Address - State:WA
Practice Address - Zip Code:99205-7674
Practice Address - Country:US
Practice Address - Phone:509-326-8282
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-12-21
Last Update Date:2012-12-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAP1 60183322172V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes172V00000XOther Service ProvidersCommunity Health Worker