Healthcare Provider Details

I. General information

NPI: 1609413814
Provider Name (Legal Business Name): SHANICE CARRINGTON DPT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/06/2019
Last Update Date: 03/16/2026
Certification Date: 03/16/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6041 OTTERBEIN LN APT 406
ELLICOTT CITY MD
21043-7599
US

IV. Provider business mailing address

6041 OTTERBEIN LN APT 406
ELLICOTT CITY MD
21043-7599
US

V. Phone/Fax

Practice location:
  • Phone: 631-377-2719
  • Fax:
Mailing address:
  • Phone: 631-377-2719
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number045094
License Number StateNY
# 2
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number30616
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: