Provider Demographics
NPI:1194910976
Name:CARN, DAVID EARL (PT)
Entity type:Individual
Prefix:MR
First Name:DAVID
Middle Name:EARL
Last Name:CARN
Suffix:
Gender:M
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:495 S NOVA RD STE 113
Mailing Address - Street 2:
Mailing Address - City:ORMOND BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:32174-8470
Mailing Address - Country:US
Mailing Address - Phone:386-677-4300
Mailing Address - Fax:386-615-9216
Practice Address - Street 1:495 S NOVA RD STE 113
Practice Address - Street 2:
Practice Address - City:ORMOND BEACH
Practice Address - State:FL
Practice Address - Zip Code:32174-8470
Practice Address - Country:US
Practice Address - Phone:386-677-4300
Practice Address - Fax:386-615-9216
Is Sole Proprietor?:Yes
Enumeration Date:2007-09-13
Last Update Date:2021-02-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLSA6520235Z00000X
FLPT2188225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Multi-Specialty
No235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language PathologistGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLPT2188OtherPT LICENSE NUMBER
FL5132624OtherAETNA
FL161730200OtherUS DEPARTMENT OF LABOR
FL1699893OtherGHI
FLS72163Medicare UPIN
FLY6058Medicare PIN