Provider Demographics
NPI:1821779109
Name:CARMICK, ELIZABETH AYN
Entity Type:Individual
Prefix:
First Name:ELIZABETH
Middle Name:AYN
Last Name:CARMICK
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3101 N 36TH ST APT 201
Mailing Address - Street 2:
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85018-6234
Mailing Address - Country:US
Mailing Address - Phone:650-296-6083
Mailing Address - Fax:
Practice Address - Street 1:4022 E GREENWAY RD STE 1
Practice Address - Street 2:
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85032-4798
Practice Address - Country:US
Practice Address - Phone:480-719-1644
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-07-28
Last Update Date:2023-07-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZPTA-014694225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant