Individual
CARL GUSTAFSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
PT
Contact information
Practice address
1801 W 2ND ST, MONTGOMERY, AL 36106-1503
(334) 356-1218
(334) 356-1219
Mailing address
211 SWEETBRIAR LN, PRATTVILLE, AL 36067-1935
(334) 356-1218
(334) 356-1219
Taxonomy
Speciality
Code
Description
License number
State
225100000X
Physical Therapist
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
H2732
LICENSE #
AL
Enumeration date
08/24/2006
Last updated
03/11/2013
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