Provider Demographics
NPI:1013225218
Name:BYRON, CAROLYN HAUGH (PT)
Entity Type:Individual
Prefix:MS
First Name:CAROLYN
Middle Name:HAUGH
Last Name:BYRON
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8400 RADFORD AVE STE 100
Mailing Address - Street 2:
Mailing Address - City:ALEXANDRIA
Mailing Address - State:VA
Mailing Address - Zip Code:22309-2585
Mailing Address - Country:US
Mailing Address - Phone:571-481-4547
Mailing Address - Fax:571-551-6419
Practice Address - Street 1:8400 RADFORD AVE STE 100
Practice Address - Street 2:
Practice Address - City:ALEXANDRIA
Practice Address - State:VA
Practice Address - Zip Code:22309
Practice Address - Country:US
Practice Address - Phone:571-481-4547
Practice Address - Fax:571-551-6419
Is Sole Proprietor?:No
Enumeration Date:2010-09-22
Last Update Date:2019-06-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA2305005500225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA2305005500OtherVA LICENSE