Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225100000X | Physical Therapist | 10733 | AZ |
N | 2251S0007X | Physical Therapist - Sports | ||
N | 2251X0800X | Physical Therapist - Orthopedic | ||
N | 2251X0800X | Physical Therapist - Orthopedic | PT36162 | CA |
NPI | 1336462225 |
---|---|
Provider Name | Edward Allen Carter |
First Address | Phoenix, AZ 85018-3300 |
Second Address | Phoenix, AZ 85016-4872 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 05/03/2010 |
Last Update Date | 19/03/2014 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
PT36162 | LICENSE (01) | CA |