Provider Demographics
NPI:1962564039
Name:CARSON PHYSICAL THERAPY, INC
Entity type:Organization
Organization Name:CARSON PHYSICAL THERAPY, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:ADAM
Authorized Official - Middle Name:PARKER
Authorized Official - Last Name:CARSON
Authorized Official - Suffix:
Authorized Official - Credentials:DPT
Authorized Official - Phone:501-847-0500
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
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-15
Last Update Date:2017-01-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AR1747225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
AR175266742Medicaid
AR046589Medicare UPIN