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General NPI Number Information
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NPI Number | 1053436071
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Entity Type | Individual
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Provider Name | STEVEN GLENN CARLSON RPT
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Gender | Male
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Dates
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Enumeration Date | 03/20/2007
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Last Update Date | 07/08/2007
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Provider Practice Location Address
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Address Line | 170 COREY RD.
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City | BRIGHTON
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State | MA
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Zip | 02135
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Country | US
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Telephone | 617-383-6624
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Fax | 617-738-0201
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Provider Business Mailing Address
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Address Line | 64 SURREY ST APT. C
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City | BRIGHTON
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State | MA
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Zip | 02135-2635
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Country | US
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Telephone | 617-383-6624
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Fax | 617-738-0201
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 225100000X
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Taxonomy Name | Physical Therapist
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License Number | 16956
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License Number State | MA
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