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NPI Code Detail

MEDICARE: MS. SAMANTHA ROSE CARR LAT, ATC

MEDICARE: MS. SAMANTHA ROSE CARR LAT, ATC
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
12255A2300XAthletic Trainer0126003127VA

General Provider Information

NPI Number : 1538782164
Entity Type Code : Individual
Provider Name (Legal Business Name) : MS. SAMANTHA ROSE CARR LAT, ATC
Provider Business Mailing Address
First Line : 3300 PLANTATION PKWY
Second Line :
City : FAIRFAX
State : VA
Zip : 22030-1904
Country : US
Telephone Number :
Fax Number :
Provider Business Practice Location Address
First Line : 10517 BRADDOCK RD STE D
Second Line :
City : FAIRFAX
State : VA
Zip : 22032-2275
Country : US
Telephone Number : 571-351-5618
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 05/18/2020
Last Update Date : 05/18/2020

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