Provider Demographics
NPI:1477751923
Name:CARBONARO, JAMES ANDREW (PT)
Entity Type:Individual
Prefix:MR
First Name:JAMES
Middle Name:ANDREW
Last Name:CARBONARO
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 1:1395 N COURTENAY PKWY
Mailing Address - Street 2:SUITE 102
Mailing Address - City:MERRITT ISLAND
Mailing Address - State:FL
Mailing Address - Zip Code:32953-4400
Mailing Address - Country:US
Mailing Address - Phone:603-203-1902
Mailing Address - Fax:
Practice Address - Street 1:1395 N COURTENAY PKWY
Practice Address - Street 2:SUITE 102
Practice Address - City:MERRITT ISLAND
Practice Address - State:FL
Practice Address - Zip Code:32953-4400
Practice Address - Country:US
Practice Address - Phone:603-203-1902
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-07-06
Last Update Date:2013-07-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY013275225100000X
NH1891225100000X
FL26867225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist