Provider Demographics
NPI:1194000596
Name:MCDONOUGH, KARRIE (DPT)
Entity Type:Individual
Prefix:
First Name:KARRIE
Middle Name:
Last Name:MCDONOUGH
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:PO BOX 1769
Mailing Address - Street 2:
Mailing Address - City:MIDDLEBURG
Mailing Address - State:VA
Mailing Address - Zip Code:20118-1769
Mailing Address - Country:US
Mailing Address - Phone:571-351-5618
Mailing Address - Fax:571-351-5619
Practice Address - Street 1:10517 BRADDOCK RD STE D
Practice Address - Street 2:
Practice Address - City:FAIRFAX
Practice Address - State:VA
Practice Address - Zip Code:22032-2275
Practice Address - Country:US
Practice Address - Phone:571-351-5618
Practice Address - Fax:571-351-5619
Is Sole Proprietor?:No
Enumeration Date:2011-10-17
Last Update Date:2021-08-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DCPT871261225100000X
VA2305207640225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist