Provider Demographics
NPI:1225210586
Name:CARSON, CHRISTIE (PT)
Entity Type:Individual
Prefix:
First Name:CHRISTIE
Middle Name:
Last Name:CARSON
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4031 BRIDGEWOOD LN
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28226-7105
Mailing Address - Country:US
Mailing Address - Phone:704-541-7509
Mailing Address - Fax:
Practice Address - Street 1:3403 LINDEN BERRY LN
Practice Address - Street 2:
Practice Address - City:CHARLOTTE
Practice Address - State:NC
Practice Address - Zip Code:28269-1300
Practice Address - Country:US
Practice Address - Phone:704-541-7509
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-11-28
Last Update Date:2007-11-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC3631225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist