Healthcare Provider Details

I. General information

NPI: 1508645185
Provider Name (Legal Business Name): BRIAN CARMICHAEL PT
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/25/2023
Last Update Date: 09/25/2023
Certification Date: 09/24/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1120 20TH ST NW
WASHINGTON DC
20036-3406
US

IV. Provider business mailing address

1120 20TH ST NW
WASHINGTON DC
20036-3406
US

V. Phone/Fax

Practice location:
  • Phone: 202-416-2110
  • Fax:
Mailing address:
  • Phone: 202-416-2110
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License NumberPT210002384
License Number StateDC
# 2
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number2305216037
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: