Provider Demographics
NPI:1447201819
Name:CARR, DAVID M (PT, ECS)
Entity type:Individual
Prefix:MR
First Name:DAVID
Middle Name:M
Last Name:CARR
Suffix:
Gender:M
Credentials:PT, ECS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:318 W HIGH ST
Mailing Address - Street 2:
Mailing Address - City:MOUNT STERLING
Mailing Address - State:KY
Mailing Address - Zip Code:40353-1328
Mailing Address - Country:US
Mailing Address - Phone:859-585-5105
Mailing Address - Fax:859-498-8677
Practice Address - Street 1:624 MAYSVILLE RD
Practice Address - Street 2:
Practice Address - City:MOUNT STERLING
Practice Address - State:KY
Practice Address - Zip Code:40353-9767
Practice Address - Country:US
Practice Address - Phone:859-585-5105
Practice Address - Fax:859-498-8677
Is Sole Proprietor?:No
Enumeration Date:2006-05-12
Last Update Date:2014-03-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KYKY001459225100000X
KYABPTS #43562251E1300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2251E1300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistElectrophysiology, Clinical
No225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY87000279Medicaid
KY0913001Medicare ID - Type UnspecifiedPHYSICAL THERAPIST/ECS
KYQ12059Medicare UPIN