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General NPI Number Information
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NPI Number | 1265997951
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Entity Type | Individual
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Provider Name | COREY KATHELEEN CARLSON ATC
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Gender | Female
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Dates
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Enumeration Date | 02/06/2019
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Last Update Date | 08/13/2025
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Provider Practice Location Address
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Address Line | 184 PANTHER DR
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City | SHENANDOAH
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State | VA
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Zip | 22849-3022
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Country | US
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Telephone | 540-652-8712
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Fax |
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Provider Business Mailing Address
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Address Line | 407 HERDMAN HILL RD
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City | LURAY
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State | VA
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Zip | 22835-7133
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Country | US
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Telephone | 540-631-1648
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 2255A2300X
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Taxonomy Name | Athletic Trainer
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License Number | 0126002185
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License Number State | VA
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