Provider Demographics
NPI:1497120596
Name:CARMER, PHILLIP (PTA)
Entity Type:Individual
Prefix:MR
First Name:PHILLIP
Middle Name:
Last Name:CARMER
Suffix:
Gender:M
Credentials:PTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:115 TERRA DR
Mailing Address - Street 2:
Mailing Address - City:BAY
Mailing Address - State:AR
Mailing Address - Zip Code:72411-9501
Mailing Address - Country:US
Mailing Address - Phone:870-253-9078
Mailing Address - Fax:
Practice Address - Street 1:115 TERRA DR
Practice Address - Street 2:
Practice Address - City:BAY
Practice Address - State:AR
Practice Address - Zip Code:72411-9501
Practice Address - Country:US
Practice Address - Phone:870-253-9078
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-12-01
Last Update Date:2015-12-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AR4025225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist