Provider Demographics
NPI:1447270442
Name:CARTER, JAROD BENJAMIN (DPT)
Entity type:Individual
Prefix:MR
First Name:JAROD
Middle Name:BENJAMIN
Last Name:CARTER
Suffix:
Gender:M
Credentials:DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2106 CULLEN AVE APT 205
Mailing Address - Street 2:
Mailing Address - City:AUSTIN
Mailing Address - State:TX
Mailing Address - Zip Code:78757-2538
Mailing Address - Country:US
Mailing Address - Phone:512-947-3705
Mailing Address - Fax:888-393-6601
Practice Address - Street 1:4611 BEE CAVE RD
Practice Address - Street 2:STE 212
Practice Address - City:WEST LAKE HILLS
Practice Address - State:TX
Practice Address - Zip Code:78746-5220
Practice Address - Country:US
Practice Address - Phone:512-947-3705
Practice Address - Fax:888-393-6601
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-20
Last Update Date:2011-12-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX1166010225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX8F4965Medicare PIN