Healthcare Provider Details

I. General information

NPI: 1063634608
Provider Name (Legal Business Name): MICHELLE A CARTER PT, DPT
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/03/2007
Last Update Date: 11/16/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6303 S 26TH ST
ROGERS AR
72758-4524
US

IV. Provider business mailing address

6303 S 26TH ST
ROGERS AR
72758-4524
US

V. Phone/Fax

Practice location:
  • Phone: 501-454-1040
  • Fax: 479-222-0048
Mailing address:
  • Phone: 501-454-1040
  • Fax: 479-222-0048

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2251P0200X
TaxonomyPediatric Physical Therapist
License NumberPT2695
License Number StateAR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: