Provider Demographics
NPI:1861674954
Name:CARMAN, ELISE D (PT)
Entity Type:Individual
Prefix:
First Name:ELISE
Middle Name:D
Last Name:CARMAN
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:ELISE
Other - Middle Name:D
Other - Last Name:MILNER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:714 DERBY ST
Mailing Address - Street 2:
Mailing Address - City:RAYMORE
Mailing Address - State:MO
Mailing Address - Zip Code:64083-8564
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:1500 MEADOW LAKE PKWY
Practice Address - Street 2:
Practice Address - City:KANSAS CITY
Practice Address - State:MO
Practice Address - Zip Code:64114-1600
Practice Address - Country:US
Practice Address - Phone:816-838-4529
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-11-29
Last Update Date:2007-11-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS11-03248225100000X
MO2002028063225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist