Provider Demographics
NPI:1649319211
Name:CARTER, KAREN LEIGH (PT)
Entity type:Individual
Prefix:
First Name:KAREN
Middle Name:LEIGH
Last Name:CARTER
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2080 W 1730 N
Mailing Address - Street 2:
Mailing Address - City:PROVO
Mailing Address - State:UT
Mailing Address - Zip Code:84604-1130
Mailing Address - Country:US
Mailing Address - Phone:801-360-3703
Mailing Address - Fax:801-756-7043
Practice Address - Street 1:44 RED PINE DR
Practice Address - Street 2:
Practice Address - City:ALPINE
Practice Address - State:UT
Practice Address - Zip Code:84004-1557
Practice Address - Country:US
Practice Address - Phone:801-756-7061
Practice Address - Fax:801-756-7043
Is Sole Proprietor?:No
Enumeration Date:2007-02-06
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT5413216-2401225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist