Provider Demographics
NPI:1558742296
Name:CARR, KEVIN S (DPT)
Entity Type:Individual
Prefix:
First Name:KEVIN
Middle Name:S
Last Name:CARR
Suffix:
Gender:M
Credentials:DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:15 MCCABE DR
Mailing Address - Street 2:SUITE 101
Mailing Address - City:RENO
Mailing Address - State:NV
Mailing Address - Zip Code:89511-5924
Mailing Address - Country:US
Mailing Address - Phone:775-788-5599
Mailing Address - Fax:775-788-5598
Practice Address - Street 1:15 MCCABE DR
Practice Address - Street 2:SUITE 101
Practice Address - City:RENO
Practice Address - State:NV
Practice Address - Zip Code:89511-5924
Practice Address - Country:US
Practice Address - Phone:775-788-5599
Practice Address - Fax:775-788-5598
Is Sole Proprietor?:No
Enumeration Date:2015-06-17
Last Update Date:2015-06-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NV3140225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NV3140OtherLICNESE