Provider Demographics
NPI:1467923987
Name:CARMACK, PETER
Entity type:Individual
Prefix:
First Name:PETER
Middle Name:
Last Name:CARMACK
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:48 SILVER ST FL 1
Mailing Address - Street 2:
Mailing Address - City:FITCHBURG
Mailing Address - State:MA
Mailing Address - Zip Code:01420-5212
Mailing Address - Country:US
Mailing Address - Phone:208-403-9972
Mailing Address - Fax:
Practice Address - Street 1:48 SILVER ST FL 1
Practice Address - Street 2:
Practice Address - City:FITCHBURG
Practice Address - State:MA
Practice Address - Zip Code:01420-5212
Practice Address - Country:US
Practice Address - Phone:208-403-9972
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-12-10
Last Update Date:2018-12-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes222Q00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersDevelopmental Therapist