MEDICARE: MRS. MARCY K. CARMACK MPT

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	225100000X	Physical Therapist	6586	CO

General Provider Information

NPI Number	:	1295955714
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. MARCY K. CARMACK MPT

Provider Business Mailing Address
First Line	:	7272 PRAIRIE WIND DR
Second Line	:
City	:	COLORADO SPRINGS
State	:	CO
Zip	:	80918-8728
Country	:	US
Telephone Number	:	719-590-7824
Fax Number	:

Provider Business Practice Location Address
First Line	:	7272 PRAIRIE WIND DR
Second Line	:
City	:	COLORADO SPRINGS
State	:	CO
Zip	:	80918-8728
Country	:	US
Telephone Number	:	719-590-7824
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	04/26/2007
Last Update Date	:	07/08/2007

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