Charles Anthony Carbonar, DPT

Primary specialty

Physical TherapistTaxonomy code 225100000X

License

040-0134096 Issued in VT

Practice address

80 Colchester Ave
Burlington, VT 05401-1417

Phone

(802) 657-7779

NPI assigned

Aug 21, 2019

Sex

Male

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Other identifiers 2

Electronic endpoints 1

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Enrolled

State licenses

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1566345600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1591747200000",
    "number": "1790332013",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "426 INDUSTRIAL AVE STE 190",
            "city": "WILLISTON",
            "state": "VT",
            "postal_code": "054957904",
            "telephone_number": "610-203-9136",
            "fax_number": "802-876-7095"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "80 COLCHESTER AVE",
            "city": "BURLINGTON",
            "state": "VT",
            "postal_code": "054011417",
            "telephone_number": "802-657-7779"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "426 Industrial Ave Ste 190",
            "address_purpose": "LOCATION",
            "city": "Williston",
            "state": "VT",
            "postal_code": "054957904",
            "country_code": "US",
            "telephone_number": "802-860-4360",
            "fax_number": "802-488-3160",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "CARBONAR",
        "first_name": "CHARLES",
        "middle_name": "ANTHONY",
        "credential": "DPT",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2019-08-21",
        "last_updated": "2020-06-10",
        "certification_date": "2020-06-10",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "225100000X",
            "taxonomy_group": "",
            "desc": "Physical Therapist",
            "state": "VT",
            "license": "040-0134096",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "6702786",
            "state": "VT"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "STATE OF VERMONT LICENSE",
            "identifier": "040-0134096",
            "state": "VT"
        }
    ],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "tony@pt360coop.com",
            "affiliation": "N",
            "endpointDescription": "work email",
            "address_1": "426 Industrial Ave Ste 190",
            "city": "Williston",
            "state": "VT",
            "country_code": "US",
            "postal_code": "054957904",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

• Eleanor Lacava Capeless, M.D.
• Mark Atlee Capeless, M.D.
• Michael James Cappella, MS, ATC
• Mary Cappleman-Sinz, LICSW
• Jessie Anne Caprino, MD
• Kevin T Carey, M.D.
• Rebecca Francesca Cariati, L.AC., T.C.M.P., M.A
• Tracie Carlson, LCMHC
• Corey Carmichael, LICSW
• Brendan James Carney, DO

• All providers in Burlington, VT
• Physical Therapist in Vermont

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 10, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.