Provider Demographics
NPI:1588631444
Name:CARLSON, CARLA RUTH (PT)
Entity Type:Individual
Prefix:MRS
First Name:CARLA
Middle Name:RUTH
Last Name:CARLSON
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 1:31 CADWALLADER CT
Mailing Address - Street 2:
Mailing Address - City:YARDLEY
Mailing Address - State:PA
Mailing Address - Zip Code:19067-1514
Mailing Address - Country:US
Mailing Address - Phone:215-321-6110
Mailing Address - Fax:
Practice Address - Street 1:2500 BRUNSWICK PIKE
Practice Address - Street 2:
Practice Address - City:LAWRENCEVILLE
Practice Address - State:NJ
Practice Address - Zip Code:08648-4134
Practice Address - Country:US
Practice Address - Phone:609-912-0333
Practice Address - Fax:609-912-0230
Is Sole Proprietor?:No
Enumeration Date:2006-02-28
Last Update Date:2008-08-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ40QA01154100225100000X
PAPT 006648-L225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist