Provider Demographics
NPI:1144335191
Name:CARR, BRIAN W (PT)
Entity type:Individual
Prefix:MR
First Name:BRIAN
Middle Name:W
Last Name:CARR
Suffix:
Gender:M
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:790 REMINGTON BLVD
Mailing Address - Street 2:
Mailing Address - City:BOLINGBROOK
Mailing Address - State:IL
Mailing Address - Zip Code:60440-4909
Mailing Address - Country:US
Mailing Address - Phone:512-876-2111
Mailing Address - Fax:
Practice Address - Street 1:1013 W UNIVERSITY AVE STE 335
Practice Address - Street 2:
Practice Address - City:GEORGETOWN
Practice Address - State:TX
Practice Address - Zip Code:78628-5343
Practice Address - Country:US
Practice Address - Phone:512-876-2111
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-08-20
Last Update Date:2024-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX11300946225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX742862345OtherGREAT WEST
TX742862345OtherHEALTHSMART
TX742862345OtherPHCS
TX2274981/5464990OtherFIRST HEALTH
TX7704625OtherAETNA
TX74-2862345OtherCIGNA
TX742862345OtherGALAXY
TX742862345OtherGOLDEN RULE
TX742862345OtherTRUE CHOICE
TX742862345OtherSCOTT & WHITE
TX742862345OtherHUMANA
TX8T2938/0092EXOtherBCBS
TX742862345OtherUNICARE