Provider Demographics
NPI:1053436071
Name:CARLSON, STEVEN GLENN (RPT)
Entity type:Individual
Prefix:MR
First Name:STEVEN
Middle Name:GLENN
Last Name:CARLSON
Suffix:
Gender:M
Credentials:RPT
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:64 SURREY ST
Mailing Address - Street 2:APT. C
Mailing Address - City:BRIGHTON
Mailing Address - State:MA
Mailing Address - Zip Code:02135-2635
Mailing Address - Country:US
Mailing Address - Phone:617-383-6624
Mailing Address - Fax:617-738-0201
Practice Address - Street 1:170 COREY RD.
Practice Address - Street 2:
Practice Address - City:BRIGHTON
Practice Address - State:MA
Practice Address - Zip Code:02135
Practice Address - Country:US
Practice Address - Phone:617-383-6624
Practice Address - Fax:617-738-0201
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-20
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MA16956225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist