Provider Demographics
NPI:1285880930
Name:CARTER, ADENA MERYL (PT)
Entity type:Individual
Prefix:MRS
First Name:ADENA
Middle Name:MERYL
Last Name:CARTER
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1209 SUNNYSIDE RD
Mailing Address - Street 2:
Mailing Address - City:ANACONDA
Mailing Address - State:MT
Mailing Address - Zip Code:59711-1766
Mailing Address - Country:US
Mailing Address - Phone:406-563-7114
Mailing Address - Fax:
Practice Address - Street 1:401 W PENNSYLVANIA ST
Practice Address - Street 2:
Practice Address - City:ANACONDA
Practice Address - State:MT
Practice Address - Zip Code:59711-1931
Practice Address - Country:US
Practice Address - Phone:406-563-8590
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-08-13
Last Update Date:2008-08-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MT1308225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MT1308PTMedicaid