Provider Demographics
NPI:1932741493
Name:CARLSON, SEAN DAVID (ATC)
Entity Type:Individual
Prefix:
First Name:SEAN
Middle Name:DAVID
Last Name:CARLSON
Suffix:
Gender:M
Credentials:ATC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5851 LARKWOOD CT APT 3A
Mailing Address - Street 2:
Mailing Address - City:KALAMAZOO
Mailing Address - State:MI
Mailing Address - Zip Code:49048-6654
Mailing Address - Country:US
Mailing Address - Phone:812-361-9398
Mailing Address - Fax:
Practice Address - Street 1:2107 N 26TH ST
Practice Address - Street 2:
Practice Address - City:KALAMAZOO
Practice Address - State:MI
Practice Address - Zip Code:49048-9217
Practice Address - Country:US
Practice Address - Phone:812-361-9398
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-10-16
Last Update Date:2019-10-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer