Provider Demographics
NPI:1821406133
Name:CARLSON, MATTHEW FELIX (MS, ATC, CSCS)
Entity Type:Individual
Prefix:
First Name:MATTHEW
Middle Name:FELIX
Last Name:CARLSON
Suffix:
Gender:M
Credentials:MS, ATC, CSCS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1751 36TH AVE S APT 208
Mailing Address - Street 2:
Mailing Address - City:GRAND FORKS
Mailing Address - State:ND
Mailing Address - Zip Code:58201-7349
Mailing Address - Country:US
Mailing Address - Phone:813-503-4071
Mailing Address - Fax:
Practice Address - Street 1:ROLLINS COLLEGE
Practice Address - Street 2:1000 HOLT AVE-2730
Practice Address - City:WINTER PARK
Practice Address - State:FL
Practice Address - Zip Code:32789
Practice Address - Country:US
Practice Address - Phone:407-646-2628
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-07-30
Last Update Date:2019-05-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer