Provider Demographics
NPI:1912386079
Name:CARSON, CAROL (ATC)
Entity Type:Individual
Prefix:
First Name:CAROL
Middle Name:
Last Name:CARSON
Suffix:
Gender:F
Credentials:ATC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3400 N WESLEYAN BLVD
Mailing Address - Street 2:
Mailing Address - City:ROCKY MOUNT
Mailing Address - State:NC
Mailing Address - Zip Code:27804-8699
Mailing Address - Country:US
Mailing Address - Phone:252-985-5221
Mailing Address - Fax:252-985-5252
Practice Address - Street 1:3400 N WESLEYAN BLVD
Practice Address - Street 2:
Practice Address - City:ROCKY MOUNT
Practice Address - State:NC
Practice Address - Zip Code:27804-8699
Practice Address - Country:US
Practice Address - Phone:252-985-5221
Practice Address - Fax:252-985-5252
Is Sole Proprietor?:Yes
Enumeration Date:2015-05-22
Last Update Date:2015-05-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC0742255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer