Healthcare Provider Details

I. General information

NPI: 1720141138
Provider Name (Legal Business Name): ELISSA DICARLO PT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/18/2006
Last Update Date: 10/09/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2021 K ST NW STE 500 SPORTS AND SPINAL PHYSICAL THERAPY
WASHINGTON DC
20006-1003
US

IV. Provider business mailing address

2021 K ST NW STE 500 SPORTS AND SPINAL PHYSICAL THERAPY
WASHINGTON DC
20006-1003
US

V. Phone/Fax

Practice location:
  • Phone: 301-736-7611
  • Fax: 301-736-7669
Mailing address:
  • Phone: 202-736-7611
  • Fax: 301-736-7669

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number4800
License Number StateVA
# 2
Primary TaxonomyN
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License NumberPT870882
License Number StateDC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: