Provider Demographics
NPI:1427251818
Name:CARNER, ALICIA G (GPT)
Entity type:Individual
Prefix:MS
First Name:ALICIA
Middle Name:G
Last Name:CARNER
Suffix:
Gender:F
Credentials:GPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Mailing Address - Street 1:4812 E 33RD ST
Mailing Address - Street 2:
Mailing Address - City:TULSA
Mailing Address - State:OK
Mailing Address - Zip Code:74135-2038
Mailing Address - Country:US
Mailing Address - Phone:918-622-4126
Mailing Address - Fax:918-270-2398
Practice Address - Street 1:209 E ROGERS BLVD
Practice Address - Street 2:
Practice Address - City:SKIATOOK
Practice Address - State:OK
Practice Address - Zip Code:74070-1251
Practice Address - Country:US
Practice Address - Phone:918-396-9799
Practice Address - Fax:918-396-9891
Is Sole Proprietor?:No
Enumeration Date:2007-06-06
Last Update Date:2014-04-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK4034225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK200117540AMedicaid
OK200117540AMedicaid
OK246727007Medicare PIN
OKAAA1967Medicare UPIN