Provider Demographics
NPI:1528191749
Name:CARSON PHYSICAL THERAPY, INC.
Entity Type:Organization
Organization Name:CARSON PHYSICAL THERAPY, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER, FACILITY ADMINISTRATOR
Authorized Official - Prefix:MS
Authorized Official - First Name:CORINNE
Authorized Official - Middle Name:
Authorized Official - Last Name:HOLMES
Authorized Official - Suffix:
Authorized Official - Credentials:PT
Authorized Official - Phone:775-882-2211
Mailing Address - Street 1:PO BOX 3450
Mailing Address - Street 2:
Mailing Address - City:CARSON CITY
Mailing Address - State:NV
Mailing Address - Zip Code:89702-3450
Mailing Address - Country:US
Mailing Address - Phone:775-882-2211
Mailing Address - Fax:775-882-2212
Practice Address - Street 1:680 W NYE LN
Practice Address - Street 2:SUITE 205
Practice Address - City:CARSON CITY
Practice Address - State:NV
Practice Address - Zip Code:89703-1575
Practice Address - Country:US
Practice Address - Phone:775-882-2211
Practice Address - Fax:775-882-2212
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-14
Last Update Date:2011-06-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NV261QP2000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2000XAmbulatory Health Care FacilitiesClinic/CenterPhysical Therapy
Provider Identifiers
StateIdentifier IDID TypeIssuer
NVV32739Medicare PIN