MEDICARE: DR. CHRISTOPHER EUGENE CARTER 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
1	225100000X	Physical Therapist	296147	CA

General Provider Information

NPI Number	:	1972200152
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. CHRISTOPHER EUGENE CARTER DPT

Provider Business Mailing Address
First Line	:	536 GRAND CANAL
Second Line	:
City	:	IRVINE
State	:	CA
Zip	:	92620-1881
Country	:	US
Telephone Number	:	910-398-4174
Fax Number	:

Provider Business Practice Location Address
First Line	:	35410 DEL REY
Second Line	:
City	:	CAPISTRANO BEACH
State	:	CA
Zip	:	92624-1814
Country	:	US
Telephone Number	:	949-496-5786
Fax Number	:

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

Provider Enumeration Date	:	02/08/2023
Last Update Date	:	02/08/2023

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