Provider Demographics
NPI:1407171531
Name:CARR, MICHAEL DAVID (PT, LAT)
Entity Type:Individual
Prefix:MR
First Name:MICHAEL
Middle Name:DAVID
Last Name:CARR
Suffix:
Gender:M
Credentials:PT, LAT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11277 VERNON PL STE 102
Mailing Address - Street 2:
Mailing Address - City:MEADVILLE
Mailing Address - State:PA
Mailing Address - Zip Code:16335-3718
Mailing Address - Country:US
Mailing Address - Phone:814-333-5214
Mailing Address - Fax:814-333-1482
Practice Address - Street 1:11277 VERNON PL STE 102
Practice Address - Street 2:
Practice Address - City:MEADVILLE
Practice Address - State:PA
Practice Address - Zip Code:16335-3718
Practice Address - Country:US
Practice Address - Phone:814-333-5214
Practice Address - Fax:814-333-1482
Is Sole Proprietor?:Yes
Enumeration Date:2010-03-31
Last Update Date:2019-07-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PART001868A2255A2300X
PAPT013071L225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
No2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer