Provider Demographics
NPI:1235422874
Name:CARRIER, BRENDA ELIZABETH (DPT)
Entity Type:Individual
Prefix:MRS
First Name:BRENDA
Middle Name:ELIZABETH
Last Name:CARRIER
Suffix:
Gender:F
Credentials:DPT
Other - Prefix:MISS
Other - First Name:BRENDA
Other - Middle Name:ELIZABETH
Other - Last Name:EATON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DPT
Mailing Address - Street 1:2330 DULLES STATION BLVD
Mailing Address - Street 2:APT 2253
Mailing Address - City:HERNDON
Mailing Address - State:VA
Mailing Address - Zip Code:20171-6191
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:2330 DULLES STATION BLVD
Practice Address - Street 2:APT 2253
Practice Address - City:HERNDON
Practice Address - State:VA
Practice Address - Zip Code:20171-6191
Practice Address - Country:US
Practice Address - Phone:814-229-1012
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-05-16
Last Update Date:2011-05-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA2305206763225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist