Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 2251X0800X | Physical Therapist - Orthopedic | 2279 | NE |
NPI | 1023061124 |
---|---|
Provider Name | Mrs. Tara L Carlson |
First Address | Lincoln, NE 68510-2564 |
Second Address | Lincoln, NE 68510-2564 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 18/05/2006 |
Last Update Date | 13/07/2011 |