Provider Demographics
NPI:1356383764
Name:SUE CARVER, A.T.C./M.P.T.
Entity type:Organization
Organization Name:SUE CARVER, A.T.C./M.P.T.
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER/PHYSICAL THERAPIST
Authorized Official - Prefix:
Authorized Official - First Name:SUE
Authorized Official - Middle Name:
Authorized Official - Last Name:CARVER
Authorized Official - Suffix:
Authorized Official - Credentials:ATC/MPT
Authorized Official - Phone:501-227-9920
Mailing Address - Street 1:PO BOX 17050
Mailing Address - Street 2:
Mailing Address - City:LITTLE ROCK
Mailing Address - State:AR
Mailing Address - Zip Code:72222-7050
Mailing Address - Country:US
Mailing Address - Phone:501-227-9920
Mailing Address - Fax:501-227-5223
Practice Address - Street 1:12600 CANTRELL RD
Practice Address - Street 2:
Practice Address - City:LITTLE ROCK
Practice Address - State:AR
Practice Address - Zip Code:72223-1604
Practice Address - Country:US
Practice Address - Phone:501-227-9920
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-11
Last Update Date:2008-08-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ARPT905225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
AR172836400OtherWORKERS COMPENSATION
AR56410Medicare ID - Type UnspecifiedPROVIDER NUMBER