Provider Demographics
NPI:1396722310
Name:CARLSON, CRAIG K (PT)
Entity type:Individual
Prefix:
First Name:CRAIG
Middle Name:K
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 1:8495 161ST AVE NE
Mailing Address - Street 2:
Mailing Address - City:REDMOND
Mailing Address - State:WA
Mailing Address - Zip Code:98052-3849
Mailing Address - Country:US
Mailing Address - Phone:425-881-3001
Mailing Address - Fax:425-881-3585
Practice Address - Street 1:8495 161ST AVE NE
Practice Address - Street 2:
Practice Address - City:REDMOND
Practice Address - State:WA
Practice Address - Zip Code:98052-3849
Practice Address - Country:US
Practice Address - Phone:425-881-3001
Practice Address - Fax:425-881-3585
Is Sole Proprietor?:No
Enumeration Date:2005-12-30
Last Update Date:2010-11-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAPT00007837225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA8335697Medicaid
WAP38107Medicare UPIN
WA8335697Medicaid