Provider Demographics
NPI:1427077130
Name:CARRICO, MATTHEW K (PT)
Entity type:Individual
Prefix:
First Name:MATTHEW
Middle Name:K
Last Name:CARRICO
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 1:38 SANDY BROOK DR
Mailing Address - Street 2:
Mailing Address - City:DURHAM
Mailing Address - State:NH
Mailing Address - Zip Code:03824-3138
Mailing Address - Country:US
Mailing Address - Phone:603-953-5147
Mailing Address - Fax:
Practice Address - Street 1:38 SANDY BROOK DR
Practice Address - Street 2:
Practice Address - City:DURHAM
Practice Address - State:NH
Practice Address - Zip Code:03824-3138
Practice Address - Country:US
Practice Address - Phone:603-953-5147
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-07-19
Last Update Date:2013-07-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NH2771225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist