Provider Demographics
NPI:1093804262
Name:CARSON, DIRK A (PT)
Entity Type:Individual
Prefix:
First Name:DIRK
Middle Name:A
Last Name:CARSON
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 1:4466 JEFF RD
Mailing Address - Street 2:
Mailing Address - City:TONEY
Mailing Address - State:AL
Mailing Address - Zip Code:35773-9791
Mailing Address - Country:US
Mailing Address - Phone:256-213-1917
Mailing Address - Fax:
Practice Address - Street 1:4466A JEFF RD
Practice Address - Street 2:
Practice Address - City:TONEY
Practice Address - State:AL
Practice Address - Zip Code:35773-9791
Practice Address - Country:US
Practice Address - Phone:256-213-1917
Practice Address - Fax:205-383-1251
Is Sole Proprietor?:No
Enumeration Date:2006-10-12
Last Update Date:2023-07-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ALPTH1734225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist