Provider Demographics
NPI:1932481983
Name:CARLSON, ANDREW KENNETH (DPT)
Entity Type:Individual
Prefix:
First Name:ANDREW
Middle Name:KENNETH
Last Name:CARLSON
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 1:24630 SANDHILL BLVD
Mailing Address - Street 2:UNIT 303
Mailing Address - City:PUNTA GORDA
Mailing Address - State:FL
Mailing Address - Zip Code:33983-5229
Mailing Address - Country:US
Mailing Address - Phone:941-255-7863
Mailing Address - Fax:
Practice Address - Street 1:24630 SANDHILL BLVD
Practice Address - Street 2:UNIT 303
Practice Address - City:PUNTA GORDA
Practice Address - State:FL
Practice Address - Zip Code:33983-5229
Practice Address - Country:US
Practice Address - Phone:941-255-7863
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-09-15
Last Update Date:2011-09-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPT26809225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist