Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 2251X0800X | Physical Therapist - Orthopedic |
NPI | 1063936698 |
---|---|
Provider Name | Teagan Melise Carter |
First Address | Lake Stevens, WA 98258-1937 |
Second Address | Lake Stevens, WA 98258-1937 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 26/07/2017 |
Last Update Date | 14/05/2020 |