Provider Demographics
NPI:1336194745
Name:CARTER REHABILITATION LLC
Entity Type:Organization
Organization Name:CARTER REHABILITATION LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICAL THERAPIST- OWNER
Authorized Official - Prefix:
Authorized Official - First Name:JOSEPH
Authorized Official - Middle Name:MICHAEL
Authorized Official - Last Name:CARTER
Authorized Official - Suffix:
Authorized Official - Credentials:PT, DPT
Authorized Official - Phone:928-226-0792
Mailing Address - Street 1:1300 S MILTON RD
Mailing Address - Street 2:SUITE 125
Mailing Address - City:FLAGSTAFF
Mailing Address - State:AZ
Mailing Address - Zip Code:86001-7302
Mailing Address - Country:US
Mailing Address - Phone:928-226-0792
Mailing Address - Fax:928-779-6408
Practice Address - Street 1:1300 S MILTON RD
Practice Address - Street 2:SUITE 125
Practice Address - City:FLAGSTAFF
Practice Address - State:AZ
Practice Address - Zip Code:86001-6398
Practice Address - Country:US
Practice Address - Phone:928-226-0792
Practice Address - Fax:928-779-6408
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-24
Last Update Date:2013-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ80276892261QP2000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2000XAmbulatory Health Care FacilitiesClinic/CenterPhysical Therapy
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZZ117315Medicare PIN
AZZ109606Medicare PIN