Provider Demographics
NPI:1588617385
Name:CARL, ROBERT CHRISTOPHER (PT MS)
Entity Type:Individual
Prefix:
First Name:ROBERT
Middle Name:CHRISTOPHER
Last Name:CARL
Suffix:
Gender:M
Credentials:PT MS
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:9097 E DESERT COVE AVE
Mailing Address - Street 2:SUITE 110
Mailing Address - City:SCOTTSDALE
Mailing Address - State:AZ
Mailing Address - Zip Code:85260-6279
Mailing Address - Country:US
Mailing Address - Phone:480-860-4298
Mailing Address - Fax:480-860-0356
Practice Address - Street 1:1616 N LITCHFIELD RD
Practice Address - Street 2:SUITE 115
Practice Address - City:GOODYEAR
Practice Address - State:AZ
Practice Address - Zip Code:85338-1252
Practice Address - Country:US
Practice Address - Phone:623-935-0734
Practice Address - Fax:623-935-0934
Is Sole Proprietor?:No
Enumeration Date:2006-05-19
Last Update Date:2007-07-08
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
AZ1793225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ107063Medicare ID - Type Unspecified
AZ114766Medicare ID - Type Unspecified