MEDICARE: MICHELLE M CARR PT

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	P16617	NC

General Provider Information

NPI Number	:	1588608905
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MICHELLE M CARR PT

Provider Business Mailing Address
First Line	:	P.O. BOX 961205
Second Line	:
City	:	FORT WORTH
State	:	TX
Zip	:	76161-1205
Country	:	US
Telephone Number	:	817-740-8400
Fax Number	:	817-810-0054

Provider Business Practice Location Address
First Line	:	1651 W ROSEDALE ST STE 200
Second Line	:
City	:	FORT WORTH
State	:	TX
Zip	:	76104-7437
Country	:	US
Telephone Number	:	817-810-0001
Fax Number	:	817-810-0054

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

Provider Enumeration Date	:	06/15/2006
Last Update Date	:	10/03/2018

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Directions to “ MICHELLE M CARR PT” Practice Location

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