Healthcare Provider Details

I. General information

NPI: 1932615663
Provider Name (Legal Business Name): CARSONPT4.0
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/18/2017
Last Update Date: 12/02/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

200 NW 4TH ST
BRYANT AR
72022-3424
US

IV. Provider business mailing address

1509 WINSLOW DR
LITTLE ROCK AR
72207-6119
US

V. Phone/Fax

Practice location:
  • Phone: 501-952-0074
  • Fax: 501-847-0508
Mailing address:
  • Phone: 501-952-0074
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QP2000X
TaxonomyPhysical Therapy Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: DR. ADAM PARKER CARSON
Title or Position: SOLE OWNER
Credential: DPT
Phone: 501-184-7050