Healthcare Provider Details

I. General information

NPI: 1760525802
Provider Name (Legal Business Name): DAVID PHILIP CARRIER M.A., ATC
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/15/2007
Last Update Date: 07/09/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

ATHLETIC DEPT. MICHIGAN STATE UNIVERSITY JENISON FIELDHOUSE
E. LANSING MI
48824
US

IV. Provider business mailing address

5937 VILLAGE DR
HASLETT MI
48840-9503
US

V. Phone/Fax

Practice location:
  • Phone: 517-353-4564
  • Fax: 517-432-1879
Mailing address:
  • Phone: 517-339-3743
  • Fax: 517-432-1879

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2255A2300X
TaxonomyAthletic Trainer
License Number
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: