Provider Demographics
NPI:1467740365
Name:CARSON, MICHAEL CHRISTOPHER (PT)
Entity Type:Individual
Prefix:
First Name:MICHAEL
Middle Name:CHRISTOPHER
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 1:101 SIVLEY RD SW
Mailing Address - Street 2:120 GOVENORS DR SE
Mailing Address - City:HUNTSVILLE
Mailing Address - State:AL
Mailing Address - Zip Code:35801-4421
Mailing Address - Country:US
Mailing Address - Phone:256-265-7952
Mailing Address - Fax:256-265-7953
Practice Address - Street 1:101 SIVLEY RD SW
Practice Address - Street 2:120 GOVENORS SW
Practice Address - City:HUNTSVILLE
Practice Address - State:AL
Practice Address - Zip Code:35801-4421
Practice Address - Country:US
Practice Address - Phone:256-265-7952
Practice Address - Fax:256-265-7953
Is Sole Proprietor?:Yes
Enumeration Date:2011-07-13
Last Update Date:2015-08-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPT266222251P0200X
ALPTH70442251P0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2251P0200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistPediatrics