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General NPI Number Information
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NPI Number | 1982980082
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Entity Type | Individual
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Provider Name | TREVOR E CARLSON PT
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Gender | Male
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Dates
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Enumeration Date | 11/02/2011
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Last Update Date | 04/19/2013
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Provider Practice Location Address
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Address Line | 1585 HEARTWOOD DR STE H
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City | MCKINLEYVILLE
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State | CA
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Zip | 95519-3993
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Country | US
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Telephone | 707-839-1802
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Fax | 707-839-3507
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Provider Business Mailing Address
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Address Line | 2306 DEAN ST
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City | EUREKA
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State | CA
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Zip | 95501-3209
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Country | US
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Telephone | 707-443-8354
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Fax | 707-443-8628
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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 | 174400000X
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Taxonomy Name | Specialist
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License Number | PT38366
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License Number State | CA
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