Healthcare Provider Details

I. General information

NPI: 1124772405
Provider Name (Legal Business Name): KEVIN CHRISTOPHER CARNEY PT-A
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/07/2022
Last Update Date: 02/07/2022
Certification Date: 02/07/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1958 VIA CTR
VISTA CA
92081-6056
US

IV. Provider business mailing address

3905 WARING RD
OCEANSIDE CA
92056-4405
US

V. Phone/Fax

Practice location:
  • Phone: 760-477-1350
  • Fax: 760-754-6785
Mailing address:
  • Phone: 760-477-1350
  • Fax: 760-754-6785

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225200000X
TaxonomyPhysical Therapy Assistant
License Number51589
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: