=====================================================
General NPI Number Information
=====================================================
NPI Number | 1003629015
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | CARL SUAREZ DPT, PT
-----------------------------------------------------
Gender | Male
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 01/31/2025
-----------------------------------------------------
Last Update Date | 01/31/2025
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 1110 MAIN ST
-----------------------------------------------------
City | HARRINGTON
-----------------------------------------------------
State | ME
-----------------------------------------------------
Zip | 04643-3005
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 207-483-4022
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 8 KINGS PL
-----------------------------------------------------
City | PERRY HALL
-----------------------------------------------------
State | MD
-----------------------------------------------------
Zip | 21128-9338
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 443-760-0773
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 225100000X
-----------------------------------------------------
Taxonomy Name | Physical Therapist
-----------------------------------------------------
License Number | PT7041
-----------------------------------------------------
License Number State | ME
-----------------------------------------------------