Provider Demographics
NPI:1144505934
Name:YAEGER, CARRIE A (PT, DPT)
Entity type:Individual
Prefix:
First Name:CARRIE
Middle Name:A
Last Name:YAEGER
Suffix:
Gender:F
Credentials:PT, DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9097 E DESERT COVE AVE STE 110
Mailing Address - Street 2:
Mailing Address - City:SCOTTSDALE
Mailing Address - State:AZ
Mailing Address - Zip Code:85260-6276
Mailing Address - Country:US
Mailing Address - Phone:480-502-5361
Mailing Address - Fax:480-502-5369
Practice Address - Street 1:15255 N 40TH ST STE 123
Practice Address - Street 2:
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85032-4638
Practice Address - Country:US
Practice Address - Phone:480-502-5361
Practice Address - Fax:480-502-5369
Is Sole Proprietor?:No
Enumeration Date:2011-10-12
Last Update Date:2022-03-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ9401225100000X
COPTL0012685225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ653389Medicaid