Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225100000X | Physical Therapist | PT771 | AR |
NPI | 1003044207 |
---|---|
Provider Name | Lane Carter |
First Address | Fort Smith, AR 72913-3528 |
Second Address | Fort Smith, AR 72903-4067 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 25/06/2009 |
Last Update Date | 04/05/2011 |