Healthcare Provider Details

I. General information

NPI: 1912246778
Provider Name (Legal Business Name): ANNIE TERRELL CARTER PTA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/13/2013
Last Update Date: 05/15/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

330 CLAREMONT LN
CROZET VA
22932-3386
US

IV. Provider business mailing address

1117 MOUNTAIN RD
AFTON VA
22920-5023
US

V. Phone/Fax

Practice location:
  • Phone: 434-812-3077
  • Fax: 434-823-7681
Mailing address:
  • Phone: 540-471-7703
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225200000X
TaxonomyPhysical Therapy Assistant
License Number2306601615
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: