Provider Demographics
NPI:1699920207
Name:CARLI, MARK EDWIN (PT)
Entity type:Individual
Prefix:MR
First Name:MARK
Middle Name:EDWIN
Last Name:CARLI
Suffix:
Gender:M
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3108 CLEARWATER DR STE B2
Mailing Address - Street 2:
Mailing Address - City:PRESCOTT
Mailing Address - State:AZ
Mailing Address - Zip Code:86305-7170
Mailing Address - Country:US
Mailing Address - Phone:928-777-9890
Mailing Address - Fax:928-777-9891
Practice Address - Street 1:3108 CLEARWATER DR STE B2
Practice Address - Street 2:
Practice Address - City:PRESCOTT
Practice Address - State:AZ
Practice Address - Zip Code:86305-7170
Practice Address - Country:US
Practice Address - Phone:928-777-9890
Practice Address - Fax:928-777-9891
Is Sole Proprietor?:No
Enumeration Date:2008-11-24
Last Update Date:2008-11-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ2270174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist