Individual
MR. MICHAEL CARR
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
PTA
Contact information
Practice address
4210 SABANA GRANDE AVE SE, RIO RANCHO, NM 87124-1152
(505) 892-6603
Mailing address
4210 SABANA GRANDE AVE SE, RIO RANCHO, NM 87124-1152
(505) 892-6603
Taxonomy
Speciality
Code
Description
License number
State
225100000X
Physical Therapist
806
NE
225200000X
Physical Therapy Assistant
Primary
A-0640
NM
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
099709
MEDICARE GROUP
—
05
—
10025112300
—
NE
01
—
216812
COVENTRY
—
01
—
39960
BCBS
—
Enumeration date
08/21/2008
Last updated
10/11/2008
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