Provider Demographics
NPI:1841327764
Name:CARLTON, TRAVIS (PT)
Entity type:Individual
Prefix:
First Name:TRAVIS
Middle Name:
Last Name:CARLTON
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:PO BOX 91
Mailing Address - Street 2:
Mailing Address - City:QUEEN CREEK
Mailing Address - State:AZ
Mailing Address - Zip Code:85242-0091
Mailing Address - Country:US
Mailing Address - Phone:480-593-8036
Mailing Address - Fax:480-635-8111
Practice Address - Street 1:7125 E LINCOLN DR STE A-202
Practice Address - Street 2:
Practice Address - City:PARADISE VALLEY
Practice Address - State:AZ
Practice Address - Zip Code:85253-4429
Practice Address - Country:US
Practice Address - Phone:480-593-8036
Practice Address - Fax:480-635-8111
Is Sole Proprietor?:No
Enumeration Date:2007-02-27
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ5480225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist