Provider Demographics
NPI:1487891651
Name:CARSON, ADAM PARKER (DPT)
Entity type:Individual
Prefix:DR
First Name:ADAM
Middle Name:PARKER
Last Name:CARSON
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 1:3231 MAIN ST
Mailing Address - Street 2:SUITE 3
Mailing Address - City:BRYANT
Mailing Address - State:AR
Mailing Address - Zip Code:72022-9188
Mailing Address - Country:US
Mailing Address - Phone:501-847-0500
Mailing Address - Fax:501-847-0508
Practice Address - Street 1:3231 MAIN ST
Practice Address - Street 2:SUITE 3
Practice Address - City:BRYANT
Practice Address - State:AR
Practice Address - Zip Code:72022-9188
Practice Address - Country:US
Practice Address - Phone:501-847-0500
Practice Address - Fax:501-847-0508
Is Sole Proprietor?:No
Enumeration Date:2009-01-09
Last Update Date:2010-01-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ARAR1747225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
AR159463721Medicaid