MEDICARE: SUSAN CARVER A.T.R./M.P.T.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	225100000X	Physical Therapist	PT905	AR

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	1477549756	OTHER	AR	NPI - UAMS

General Provider Information

NPI Number	:	1053352849
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	SUSAN CARVER A.T.R./M.P.T.

Provider Business Mailing Address
First Line	:	4301 W. MARKHAM ST., SLOT 547-11
Second Line	:	UNIV. OF AR FOR MEDICAL SCIENCE/REHAB SERVICES
City	:	LITTLE ROCK
State	:	AR
Zip	:	72205-7199
Country	:	US
Telephone Number	:	501-265-9027
Fax Number	:	501-296-1216

Provider Business Practice Location Address
First Line	:	4301 W. MARKHAM ST., SLOT 547-11
Second Line	:	UNIV. OF AR. FOR MEDICAL SCIENCE/REHAB. SERVICES
City	:	LITTLE ROCK
State	:	AR
Zip	:	72205-7199
Country	:	US
Telephone Number	:	501-265-9027
Fax Number	:	501-296-1216

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/10/2006
Last Update Date	:	09/24/2013

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