Healthcare Provider Details

I. General information

NPI: 1033528674
Provider Name (Legal Business Name): KERRY M CARSWELL PT, DPT
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/07/2014
Last Update Date: 07/29/2025
Certification Date: 07/29/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

800 E MAIN ST
WYTHEVILLE VA
24382-3300
US

IV. Provider business mailing address

800 E MAIN ST
WYTHEVILLE VA
24382-3300
US

V. Phone/Fax

Practice location:
  • Phone: 276-525-6043
  • Fax:
Mailing address:
  • Phone: 931-220-3233
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2251P0200X
TaxonomyPediatric Physical Therapist
License Number2305206082
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: