Healthcare Provider Details

I. General information

NPI: 1194910976
Provider Name (Legal Business Name): DAVID EARL CARN PT
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/13/2007
Last Update Date: 02/15/2021
Certification Date: 02/15/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

495 S NOVA RD STE 113
ORMOND BEACH FL
32174-8470
US

IV. Provider business mailing address

495 S NOVA RD STE 113
ORMOND BEACH FL
32174-8470
US

V. Phone/Fax

Practice location:
  • Phone: 386-677-4300
  • Fax: 386-615-9216
Mailing address:
  • Phone: 386-677-4300
  • Fax: 386-615-9216

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License NumberSA6520
License Number StateFL
# 2
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License NumberPT2188
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: