1508445446 NPI number — HANNAH CARMEN PT

Table of content: HANNAH CARMEN PT (NPI 1508445446)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1508445446 NPI number — HANNAH CARMEN PT

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
CARMEN
Provider First Name:
HANNAH
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
PT
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1508445446
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
04/07/2021
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
4896 S BRIGHT ANGEL TRL
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
FLAGSTAFF
Provider Business Mailing Address State Name:
AZ
Provider Business Mailing Address Postal Code:
86005-8369
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
928-899-5837
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
12400 HIGH BLUFF DR
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
SAN DIEGO
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
92130-3077
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
858-792-0711
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
04/07/2021

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 225100000X , with the licence number:  160063 , registered in the state of AK ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 225100000X , with the licence number: LPT-013031 , registered in the state of AZ ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: LPT-013031 . This is a "ARIZONA STATE BOARD OF PHYSICAL THERAPY" identifier , issued by the state of ( AZ ) . This identifiers is of the category "OTHER".
  • Identifier: 160063 . This is a "STATE PHYSICAL AND OCCUPATIONAL THERAPY BOARD" identifier , issued by the state of ( AK ) . This identifiers is of the category "OTHER".