Healthcare Provider Details

I. General information

NPI: 1407859515
Provider Name (Legal Business Name): MATTHEW ROBERT CARL M.S.P.T.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/23/2005
Last Update Date: 09/20/2026
Certification Date: 09/20/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7610 POST RD UNIT 4
NORTH KINGSTOWN RI
02852-3900
US

IV. Provider business mailing address

7610 POST RD UNIT 4
NORTH KINGSTOWN RI
02852-3900
US

V. Phone/Fax

Practice location:
  • Phone: 401-472-9054
  • Fax: 401-868-1992
Mailing address:
  • Phone: 401-472-9054
  • Fax: 401-868-1992

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number008064
License Number StateCT
# 2
Primary TaxonomyN
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number16252
License Number StateMA
# 3
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License NumberPT01649
License Number StateRI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: