Provider Demographics
NPI:1932615663
Name:CARSONPT4.0
Entity Type:Organization
Organization Name:CARSONPT4.0
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SOLE OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:ADAM
Authorized Official - Middle Name:PARKER
Authorized Official - Last Name:CARSON
Authorized Official - Suffix:
Authorized Official - Credentials:DPT
Authorized Official - Phone:501-184-7050
Mailing Address - Street 1:1509 WINSLOW DR
Mailing Address - Street 2:
Mailing Address - City:LITTLE ROCK
Mailing Address - State:AR
Mailing Address - Zip Code:72207-6119
Mailing Address - Country:US
Mailing Address - Phone:501-952-0074
Mailing Address - Fax:
Practice Address - Street 1:200 NW 4TH ST
Practice Address - Street 2:
Practice Address - City:BRYANT
Practice Address - State:AR
Practice Address - Zip Code:72022-3424
Practice Address - Country:US
Practice Address - Phone:501-952-0074
Practice Address - Fax:501-847-0508
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-12-18
Last Update Date:2019-12-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes261QP2000XAmbulatory Health Care FacilitiesClinic/CenterPhysical TherapyGroup - Single Specialty