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General NPI Number Information
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NPI Number | 1306396247
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Entity Type | Individual
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Provider Name | CARLIE-ANNE SAMEDY
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Gender | Female
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Dates
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Enumeration Date | 10/04/2016
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Last Update Date | 10/04/2016
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Provider Practice Location Address
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Address Line | 1401 MERCANTILE LN SUITE 107
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City | LARGO
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State | MD
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Zip | 20774-4301
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Country | US
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Telephone | 301-658-6881
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Fax |
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Provider Business Mailing Address
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Address Line | 14201 AUTUMN GOLD RD
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City | BOYDS
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State | MD
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Zip | 20841-4207
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Country | US
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Telephone |
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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 | 225100000X
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Taxonomy Name | Physical Therapist
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License Number | 26168
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License Number State | MD
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