Provider Demographics
NPI:1245484542
Name:BECKETT, CARTER (LMT, CR)
Entity type:Individual
Prefix:MR
First Name:CARTER
Middle Name:
Last Name:BECKETT
Suffix:
Gender:M
Credentials:LMT, CR
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:760 PLACITA SANTA FE
Mailing Address - Street 2:
Mailing Address - City:SANTA FE
Mailing Address - State:NM
Mailing Address - Zip Code:87505-4543
Mailing Address - Country:US
Mailing Address - Phone:505-983-5457
Mailing Address - Fax:505-983-5459
Practice Address - Street 1:760 PLACITA SANTA FE
Practice Address - Street 2:
Practice Address - City:SANTA FE
Practice Address - State:NM
Practice Address - Zip Code:87505-4543
Practice Address - Country:US
Practice Address - Phone:505-983-5457
Practice Address - Fax:505-983-5459
Is Sole Proprietor?:Yes
Enumeration Date:2008-11-13
Last Update Date:2008-11-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NM0128225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist