MEDICARE: CARLY LAIDLAW

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	2255A2300X	Athletic Trainer	0126001669	VA

General Provider Information

NPI Number	:	1023976339
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	CARLY LAIDLAW

Provider Business Mailing Address
First Line	:	1060 KEMPSVILLE RD APT 8204
Second Line	:
City	:	NORFOLK
State	:	VA
Zip	:	23502-2756
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	5817 WESLEYAN DR
Second Line	:
City	:	VIRGINIA BEACH
State	:	VA
Zip	:	23455-4637
Country	:	US
Telephone Number	:	757-937-6802
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	01/14/2026
Last Update Date	:	01/14/2026

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Directions to “ CARLY LAIDLAW ” Practice Location

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