Healthcare Provider Details

I. General information

NPI: 1568552925
Provider Name (Legal Business Name): CAROUSEL PHYSICAL THERAPY, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/13/2006
Last Update Date: 07/03/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

500 IRVINGTON ROAD
KILMARNOCK VA
22482
US

IV. Provider business mailing address

500 IRVINGTON ROAD P.O. BOX 128
KILMARNOCK VA
22482
US

V. Phone/Fax

Practice location:
  • Phone: 804-435-3435
  • Fax:
Mailing address:
  • Phone: 804-435-3435
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code174400000X
TaxonomySpecialist
License Number2305202045
License Number StateVA
# 2
Primary TaxonomyN
Taxonomy Code261QP2000X
TaxonomyPhysical Therapy Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: MRS. VICKI L VERMEER
Title or Position: PRESIDENT/ PHYSICAL THERAPIST
Credential: MSPT
Phone: 804-435-3435