Healthcare Provider Details

I. General information

NPI: 1174406748
Provider Name (Legal Business Name): COURTNEY JO CARTER LPTA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/30/2025
Last Update Date: 07/30/2025
Certification Date: 07/30/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1301 CEDAR RD
CHESAPEAKE VA
23322-7105
US

IV. Provider business mailing address

8213 JOLIMA AVE
NORFOLK VA
23518-2215
US

V. Phone/Fax

Practice location:
  • Phone: 757-512-7626
  • Fax:
Mailing address:
  • Phone: 757-748-4755
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225200000X
TaxonomyPhysical Therapy Assistant
License Number2306606727
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: