Provider Demographics
NPI:1336191824
Name:CARLSON, PAUL JOSEPH (PT)
Entity Type:Individual
Prefix:
First Name:PAUL
Middle Name:JOSEPH
Last Name:CARLSON
Suffix:
Gender:M
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:218 W 34TH AVE
Mailing Address - Street 2:
Mailing Address - City:ANCHORAGE
Mailing Address - State:AK
Mailing Address - Zip Code:99503-3977
Mailing Address - Country:US
Mailing Address - Phone:907-868-7821
Mailing Address - Fax:907-868-7584
Practice Address - Street 1:218 W 34TH AVE
Practice Address - Street 2:
Practice Address - City:ANCHORAGE
Practice Address - State:AK
Practice Address - Zip Code:99503-3977
Practice Address - Country:US
Practice Address - Phone:907-868-7821
Practice Address - Fax:907-868-7584
Is Sole Proprietor?:No
Enumeration Date:2006-05-16
Last Update Date:2008-09-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AK1683225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
AK1770757809OtherGROUP NPI
AKK161829Medicare PIN