Provider Demographics
NPI:1528013919
Name:CARTER, VALERIE ANN (PT, DPT, NCS)
Entity Type:Individual
Prefix:
First Name:VALERIE
Middle Name:ANN
Last Name:CARTER
Suffix:
Gender:F
Credentials:PT, DPT, NCS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1800 S MILTON RD
Mailing Address - Street 2:SUITE 103
Mailing Address - City:FLAGSTAFF
Mailing Address - State:AZ
Mailing Address - Zip Code:86001-6333
Mailing Address - Country:US
Mailing Address - Phone:928-226-0792
Mailing Address - Fax:928-779-6408
Practice Address - Street 1:1800 S MILTON RD
Practice Address - Street 2:SUITE 103
Practice Address - City:FLAGSTAFF
Practice Address - State:AZ
Practice Address - Zip Code:86001-6333
Practice Address - Country:US
Practice Address - Phone:928-226-0792
Practice Address - Fax:928-779-6408
Is Sole Proprietor?:No
Enumeration Date:2006-05-23
Last Update Date:2007-09-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ1849225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ186496Medicaid
AZZ110739Medicare PIN