Provider Demographics
NPI:1497891758
Name:CARR, GWENDOLYN LOUISE (PT)
Entity Type:Individual
Prefix:MS
First Name:GWENDOLYN
Middle Name:LOUISE
Last Name:CARR
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 1:412 BREEZY PT
Mailing Address - Street 2:
Mailing Address - City:CHESAPEAKE
Mailing Address - State:VA
Mailing Address - Zip Code:23322-8372
Mailing Address - Country:US
Mailing Address - Phone:757-549-1469
Mailing Address - Fax:757-427-1338
Practice Address - Street 1:412 BREEZY PT
Practice Address - Street 2:
Practice Address - City:CHESAPEAKE
Practice Address - State:VA
Practice Address - Zip Code:23322-8372
Practice Address - Country:US
Practice Address - Phone:757-549-1469
Practice Address - Fax:757-427-1338
Is Sole Proprietor?:No
Enumeration Date:2007-01-30
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA2251N0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2251N0400XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistNeurology