Healthcare Provider Details

I. General information

NPI: 1972668770
Provider Name (Legal Business Name): CRAIG M CARLSON
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/22/2006
Last Update Date: 02/14/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

18821 DELAWARE ST SUITE 103
HUNTINGTON BEACH CA
92648-1935
US

IV. Provider business mailing address

18821 DELAWARE ST SUITE 103
HUNTINGTON BEACH CA
92648-1935
US

V. Phone/Fax

Practice location:
  • Phone: 714-596-9799
  • Fax: 714-596-9739
Mailing address:
  • Phone: 714-596-9799
  • Fax: 714-596-9739

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License Number
License Number State

VIII. Authorized Official

Name: MR. CRAIG MICHAEL CARLSON
Title or Position: VP OF OPERATIONS
Credential:
Phone: 714-596-9799