Provider Demographics
NPI:1033518352
Name:ESSEX, CARISSA (DPT)
Entity Type:Individual
Prefix:
First Name:CARISSA
Middle Name:
Last Name:ESSEX
Suffix:
Gender:F
Credentials:DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6862 PIEDMONT CENTER PLZ
Mailing Address - Street 2:
Mailing Address - City:GAINESVILLE
Mailing Address - State:VA
Mailing Address - Zip Code:20155-4034
Mailing Address - Country:US
Mailing Address - Phone:703-754-4690
Mailing Address - Fax:
Practice Address - Street 1:6862 PIEDMONT CENTER PLZ
Practice Address - Street 2:
Practice Address - City:GAINESVILLE
Practice Address - State:VA
Practice Address - Zip Code:20155-4034
Practice Address - Country:US
Practice Address - Phone:703-754-4690
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-08-22
Last Update Date:2014-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA2305208720225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist