Healthcare Provider Details

I. General information

NPI: 1225181886
Provider Name (Legal Business Name): DAVID MATTHEW CARTER MSPT
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/18/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1940 SANDY HOOK RD SUITE F
GOOCHLAND VA
23063-3107
US

IV. Provider business mailing address

PO BOX 57
GOOCHLAND VA
23063-0057
US

V. Phone/Fax

Practice location:
  • Phone: 804-556-7181
  • Fax: 804-556-7182
Mailing address:
  • Phone: 804-247-1555
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2251X0800X
TaxonomyOrthopedic Physical Therapist
License Number2305004559
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: