Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225100000X | Physical Therapist | 13530 | AZ |
NPI | 1003323890 |
---|---|
Provider Name | Daniel Carter |
First Address | Phoenix, AZ 85044-6691 |
Second Address | Tempe, AZ 85284-1373 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 03/01/2018 |
Last Update Date | 03/01/2018 |