MEDICARE: CARRIE GORDON LARSON WARFEL PT

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	225100000X	Physical Therapist	18904	MD

General Provider Information

NPI Number	:	1376763193
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	CARRIE GORDON LARSON WARFEL PT

Provider Business Mailing Address
First Line	:	2601 GARRETT RD
Second Line	:
City	:	WHITE HALL
State	:	MD
Zip	:	21161-9743
Country	:	US
Telephone Number	:	410-357-9437
Fax Number	:

Provider Business Practice Location Address
First Line	:	2601 GARRETT RD
Second Line	:
City	:	WHITE HALL
State	:	MD
Zip	:	21161-9743
Country	:	US
Telephone Number	:	410-357-9437
Fax Number	:

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

Provider Enumeration Date	:	04/26/2007
Last Update Date	:	07/08/2007

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