Healthcare Provider Details

I. General information

NPI: 1205608478
Provider Name (Legal Business Name): KIARA RENEE CARTER DPT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/23/2023
Last Update Date: 10/23/2023
Certification Date: 10/23/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3084 WALDORF MARKET PL
WALDORF MD
20603-4872
US

IV. Provider business mailing address

3084 WALDORF MARKET PL
WALDORF MD
20603-4872
US

V. Phone/Fax

Practice location:
  • Phone: 240-530-8188
  • Fax: 301-638-0470
Mailing address:
  • Phone: 240-530-8188
  • Fax: 301-638-0470

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number29690
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: