Provider Demographics
NPI:1093005191
Name:CARR, ANDREW L (RMT)
Entity Type:Individual
Prefix:
First Name:ANDREW
Middle Name:L
Last Name:CARR
Suffix:
Gender:M
Credentials:RMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:6058B ESSEX HOUSE SQ
Mailing Address - Street 2:
Mailing Address - City:ALEXANDRIA
Mailing Address - State:VA
Mailing Address - Zip Code:22310-4315
Mailing Address - Country:US
Mailing Address - Phone:703-582-5115
Mailing Address - Fax:202-450-2857
Practice Address - Street 1:6058B ESSEX HOUSE SQ
Practice Address - Street 2:
Practice Address - City:ALEXANDRIA
Practice Address - State:VA
Practice Address - Zip Code:22310-4315
Practice Address - Country:US
Practice Address - Phone:703-582-5115
Practice Address - Fax:202-450-2857
Is Sole Proprietor?:Yes
Enumeration Date:2011-04-11
Last Update Date:2011-04-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DCMT124225700000X
VA0019002576225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist