Provider Demographics
NPI:1245442078
Name:DEAN, CARL W (MPT)
Entity type:Individual
Prefix:
First Name:CARL
Middle Name:W
Last Name:DEAN
Suffix:
Gender:M
Credentials:MPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:20 W MEDICAL CT
Mailing Address - Street 2:
Mailing Address - City:MARION
Mailing Address - State:NC
Mailing Address - Zip Code:28752-4968
Mailing Address - Country:US
Mailing Address - Phone:828-659-8049
Mailing Address - Fax:828-659-8639
Practice Address - Street 1:20 W MEDICAL CT
Practice Address - Street 2:
Practice Address - City:MARION
Practice Address - State:NC
Practice Address - Zip Code:28752-4968
Practice Address - Country:US
Practice Address - Phone:828-659-8049
Practice Address - Fax:828-659-8639
Is Sole Proprietor?:No
Enumeration Date:2007-05-04
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC10801225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist