MEDICARE: CAROLYN E PRICE DPT

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	174400000X	Specialist	1147001	TX

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	8T1098	OTHER	TX	BCBS PROVIDER NUMBER

General Provider Information

NPI Number	:	1437262045
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	CAROLYN E PRICE DPT

Provider Business Mailing Address
First Line	:	22715 WASHINGTON ST 102
Second Line	:
City	:	LEONARDTOWN
State	:	MD
Zip	:	20650-3814
Country	:	US
Telephone Number	:	301-997-0172
Fax Number	:	301-997-0175

Provider Business Practice Location Address
First Line	:	4407 LITTLE RD STE 680
Second Line	:
City	:	ARLINGTON
State	:	TX
Zip	:	76016-5628
Country	:	US
Telephone Number	:	817-516-1115
Fax Number	:	817-516-1104

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

Provider Enumeration Date	:	08/16/2006
Last Update Date	:	12/18/2015

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Directions to “ CAROLYN E PRICE DPT” Practice Location

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