Provider Demographics
NPI:1669259388
Name:CARTER, CEDRIC C II (LMT)
Entity type:Individual
Prefix:
First Name:CEDRIC
Middle Name:C
Last Name:CARTER
Suffix:II
Gender:M
Credentials:LMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3105 S INTERSTATE 35 APT 1022
Mailing Address - Street 2:
Mailing Address - City:AUSTIN
Mailing Address - State:TX
Mailing Address - Zip Code:78741-6928
Mailing Address - Country:US
Mailing Address - Phone:413-682-4162
Mailing Address - Fax:
Practice Address - Street 1:14028 N HWY 183 STE 120
Practice Address - Street 2:
Practice Address - City:AUSTIN
Practice Address - State:TX
Practice Address - Zip Code:78717-5996
Practice Address - Country:US
Practice Address - Phone:512-580-5808
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-09-14
Last Update Date:2023-09-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXMT136180225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist