Individual
JOHN ROBERT CARLSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
PT
Contact information
Practice address
1880 POTTERY AVE, SUITE 100, PORT ORCHARD, WA 98366
(360) 895-9090
(360) 895-9089
Mailing address
2174 SW WARBLER WAY, BREMERTON, WA 98312-8204
(360) 509-7165
Taxonomy
Speciality
Code
Description
License number
State
225100000X
Physical Therapist
Primary
PT00003990
WA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
0150494
L L
WA
05
—
8339343
—
WA
01
—
P00129558
RAILROAD MEDICARE
—
Enumeration date
05/17/2006
Last updated
10/19/2007
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