Individual
MR. MICHAEL CARR
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
PTA
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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