Provider Demographics
NPI:1699714428
Name:CARR, DANA (PT, MSPT)
Entity type:Individual
Prefix:MS
First Name:DANA
Middle Name:
Last Name:CARR
Suffix:
Gender:F
Credentials:PT, MSPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1 BROOKWAY CT
Mailing Address - Street 2:
Mailing Address - City:MANSFIELD
Mailing Address - State:TX
Mailing Address - Zip Code:76063-5416
Mailing Address - Country:US
Mailing Address - Phone:817-307-0207
Mailing Address - Fax:
Practice Address - Street 1:1 BROOKWAY CT
Practice Address - Street 2:
Practice Address - City:MANSFIELD
Practice Address - State:TX
Practice Address - Zip Code:76063-5416
Practice Address - Country:US
Practice Address - Phone:817-307-0207
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-06-06
Last Update Date:2024-11-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX1138238225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX164654901Medicaid
TXQ10032Medicare UPIN