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NPI Code Detail

MEDICARE: MARYE CARLSON PT, DPT

MEDICARE: MARYE CARLSON PT, DPT
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
1225100000XPhysical TherapistPT-2298WY

General Provider Information

NPI Number : 1417732074
Entity Type Code : Individual
Provider Name (Legal Business Name) : MARYE CARLSON PT, DPT
Provider Business Mailing Address
First Line : 497 W LOTT ST
Second Line :
City : BUFFALO
State : WY
Zip : 82834-1658
Country : US
Telephone Number : 307-684-6172
Fax Number :
Provider Business Practice Location Address
First Line : 497 W LOTT ST
Second Line :
City : BUFFALO
State : WY
Zip : 82834-1658
Country : US
Telephone Number : 307-684-6172
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 08/30/2023
Last Update Date : 08/30/2023

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Directions to “ MARYE CARLSON PT, DPT” Practice Location

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