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General NPI Number Information
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NPI Number | 1932615663
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Entity Type | Organization
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Legal Business Name | CARSONPT4.0
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Dates
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Enumeration Date | 12/18/2017
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Last Update Date | 12/02/2019
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Provider Practice Location Address
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Address Line | 200 NW 4TH ST
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City | BRYANT
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State | AR
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Zip | 72022-3424
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Country | US
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Telephone | 501-952-0074
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Fax | 501-847-0508
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Provider Business Mailing Address
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Address Line | 1509 WINSLOW DR
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City | LITTLE ROCK
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State | AR
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Zip | 72207-6119
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Country | US
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Telephone | 501-952-0074
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Fax |
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Authorized Official
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Title or Position | SOLE OWNER
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Name | DR. ADAM PARKER CARSON
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Credential | DPT
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Telephone | 501-184-7050
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QP2000X
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Taxonomy Name | Physical Therapy Clinic/Center
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License Number |
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License Number State |
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