Provider Demographics
NPI:1316941149
Name:CARTER, JOSEPH MICHAEL (PT, DPT)
Entity type:Individual
Prefix:
First Name:JOSEPH
Middle Name:MICHAEL
Last Name:CARTER
Suffix:
Gender:M
Credentials:PT, DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1800 S MILTON RD
Mailing Address - Street 2:SUITE 103
Mailing Address - City:FLAGSTAFF
Mailing Address - State:AZ
Mailing Address - Zip Code:86001-6333
Mailing Address - Country:US
Mailing Address - Phone:928-226-0792
Mailing Address - Fax:928-779-6408
Practice Address - Street 1:1800 S MILTON RD
Practice Address - Street 2:SUITE 103
Practice Address - City:FLAGSTAFF
Practice Address - State:AZ
Practice Address - Zip Code:86001-6333
Practice Address - Country:US
Practice Address - Phone:928-226-0792
Practice Address - Fax:928-779-6408
Is Sole Proprietor?:No
Enumeration Date:2005-06-09
Last Update Date:2007-09-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ4292225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ565830Medicaid
AZ565830Medicaid