Healthcare Provider Details

I. General information

NPI: 1740629914
Provider Name (Legal Business Name): NATALIE ANNE CARTER DPT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: NATALIE ANNE GEISZ DPT

II. Dates (important events)

Enumeration Date: 06/20/2013
Last Update Date: 06/25/2020
Certification Date: 06/25/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1047 CENTURY DR
EDWARDSVILLE IL
62025-3772
US

IV. Provider business mailing address

600 OAKMONT LN STE 600C
WESTMONT IL
60559-5548
US

V. Phone/Fax

Practice location:
  • Phone: 618-307-3434
  • Fax: 618-307-3435
Mailing address:
  • Phone: 630-575-1980
  • Fax: 630-928-5080

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number2013021014
License Number StateMO
# 2
Primary TaxonomyN
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number8598488-2401
License Number StateUT
# 3
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number070.021263
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: