Healthcare Provider Details

I. General information

NPI: 1578071890
Provider Name (Legal Business Name): SEAN MICHAEL CARTER ATC
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/22/2018
Last Update Date: 01/22/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8701 S HARDY DR
TEMPE AZ
85284-2800
US

IV. Provider business mailing address

1100 N PRIEST DR APT 1044
CHANDLER AZ
85226-1009
US

V. Phone/Fax

Practice location:
  • Phone: 602-379-1713
  • Fax:
Mailing address:
  • Phone: 616-498-1932
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2255A2300X
TaxonomyAthletic Trainer
License Number1599
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: