Individual
JENNIFER CARLSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PT
Contact information
Practice address
1919 LATHROP ST, SUITE 123, FAIRBANKS, AK 99701-5937
(907) 455-4401
(907) 455-4402
Mailing address
790 REMINGTON BLVD, BOLINGBROOK, IL 60440-4909
(630) 296-2223
Taxonomy
Speciality
Code
Description
License number
State
225100000X
Physical Therapist
Primary
1002
AK
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1002
PT LICENCE #
AK
Enumeration date
05/31/2006
Last updated
07/18/2016
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