Provider Demographics
NPI:1710689971
Name:CARSON PHYSICAL THERAPY
Entity Type:Organization
Organization Name:CARSON PHYSICAL THERAPY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:DIRK
Authorized Official - Middle Name:
Authorized Official - Last Name:CARSON
Authorized Official - Suffix:
Authorized Official - Credentials:PT
Authorized Official - Phone:256-213-1917
Mailing Address - Street 1:4466 JEFF RD # A
Mailing Address - Street 2:
Mailing Address - City:TONEY
Mailing Address - State:AL
Mailing Address - Zip Code:35773-9791
Mailing Address - Country:US
Mailing Address - Phone:256-213-1917
Mailing Address - Fax:
Practice Address - Street 1:4466 JEFF RD # A
Practice Address - Street 2:
Practice Address - City:TONEY
Practice Address - State:AL
Practice Address - Zip Code:35773-9791
Practice Address - Country:US
Practice Address - Phone:256-213-1917
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-03-21
Last Update Date:2023-07-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Single Specialty