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General NPI Number Information
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NPI Number | 1861443236
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Entity Type | Individual
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Provider Name | CAROL SUE LETNER D.P.T.
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Gender | Female
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Dates
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Enumeration Date | 05/12/2006
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Last Update Date | 10/22/2023
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Provider Practice Location Address
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Address Line | 4165 N BANK ST STE A
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City | KINGMAN
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State | AZ
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Zip | 86409-2725
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Country | US
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Telephone | 928-351-7651
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Fax |
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Provider Business Mailing Address
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Address Line | 4290 E TOMAHAWK DR
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City | KINGMAN
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State | AZ
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Zip | 86401-7502
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Country | US
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Telephone | 847-571-4313
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Fax |
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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 | LPT30030
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License Number State | AZ
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