MEDICARE: ELI CARTER

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	225200000X	Physical Therapy Assistant	2123	NE

General Provider Information

NPI Number	:	1356165997
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ELI CARTER

Provider Business Mailing Address
First Line	:	5218 WOODLANE DR
Second Line	:
City	:	PAPILLION
State	:	NE
Zip	:	68133-4702
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	114 E 1ST ST STE 105
Second Line	:
City	:	PAPILLION
State	:	NE
Zip	:	68046-2407
Country	:	US
Telephone Number	:	402-933-2010
Fax Number	:

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

Provider Enumeration Date	:	11/11/2024
Last Update Date	:	11/11/2024

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Directions to “ ELI CARTER ” Practice Location

Language	Start Address	Practice Location

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