Provider Demographics
NPI:1295032316
Name:CARDWELL, ANNIE CEDERBERG (PT)
Entity Type:Individual
Prefix:
First Name:ANNIE
Middle Name:CEDERBERG
Last Name:CARDWELL
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:PO BOX 1237
Mailing Address - Street 2:
Mailing Address - City:KING GEORGE
Mailing Address - State:VA
Mailing Address - Zip Code:22485-1237
Mailing Address - Country:US
Mailing Address - Phone:540-903-7298
Mailing Address - Fax:540-709-7559
Practice Address - Street 1:5254 POTOMAC DR STE A
Practice Address - Street 2:
Practice Address - City:KING GEORGE
Practice Address - State:VA
Practice Address - Zip Code:22485-5832
Practice Address - Country:US
Practice Address - Phone:540-903-7298
Practice Address - Fax:540-709-7559
Is Sole Proprietor?:No
Enumeration Date:2011-02-25
Last Update Date:2019-01-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA2305004026225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist