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General NPI Number Information
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NPI Number | 1619859956
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Entity Type | Individual
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Provider Name | KATHRYN MARIE MCCONCHIE CARTER PTA
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Gender | Female
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Dates
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Enumeration Date | 07/25/2025
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Last Update Date | 07/25/2025
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Provider Practice Location Address
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Address Line | 715 FERDINAND AVE SW
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City | ROANOKE
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State | VA
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Zip | 24016-3827
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Country | US
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Telephone | 720-938-1528
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Fax | 720-938-1528
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Provider Business Mailing Address
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Address Line | 715 FERDINAND AVE SW
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City | ROANOKE
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State | VA
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Zip | 24016-3827
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Country | US
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Telephone | 720-938-1528
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Fax | 720-938-1528
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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 | 225200000X
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Taxonomy Name | Physical Therapy Assistant
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License Number | 2306606771
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License Number State | VA
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