MEDICARE: MS. ALLYSON ELAINE 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	4059148	TX

General Provider Information

NPI Number	:	1720646755
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. ALLYSON ELAINE CARTER

Provider Business Mailing Address
First Line	:	1711 BEARWOOD LN
Second Line	:
City	:	TYLER
State	:	TX
Zip	:	75703-8101
Country	:	US
Telephone Number	:	903-954-0412
Fax Number	:

Provider Business Practice Location Address
First Line	:	2808 S MAIN ST STE C
Second Line	:
City	:	LINDALE
State	:	TX
Zip	:	75771-7854
Country	:	US
Telephone Number	:	903-780-3505
Fax Number	:

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

Provider Enumeration Date	:	06/04/2019
Last Update Date	:	06/04/2019

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