Healthcare Provider Details

I. General information

NPI: 1801709241
Provider Name (Legal Business Name): CARLA HENRY
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/25/2026
Last Update Date: 09/25/2026
Certification Date: 09/25/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4300 PLANK RD STE 120
FREDERICKSBURG VA
22407-0102
US

IV. Provider business mailing address

17308 CAMELLIA DR
RUTHER GLEN VA
22546-4806
US

V. Phone/Fax

Practice location:
  • Phone: 540-412-6536
  • Fax: 540-252-0012
Mailing address:
  • Phone: 540-412-6536
  • Fax: 540-252-0012

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225700000X
TaxonomyMassage Therapist
License Number0019016313
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: