Provider Demographics
NPI:1508820929
Name:MAIN, CARRIE ELIZABETH (PT)
Entity Type:Individual
Prefix:MS
First Name:CARRIE
Middle Name:ELIZABETH
Last Name:MAIN
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:7404 EXECUTIVE PL
Mailing Address - Street 2:#300B
Mailing Address - City:LANHAM
Mailing Address - State:MD
Mailing Address - Zip Code:20706-2268
Mailing Address - Country:US
Mailing Address - Phone:301-599-5900
Mailing Address - Fax:301-856-7685
Practice Address - Street 1:8118 GOOD LUCK RD
Practice Address - Street 2:
Practice Address - City:LANHAM
Practice Address - State:MD
Practice Address - Zip Code:20706
Practice Address - Country:US
Practice Address - Phone:301-552-8144
Practice Address - Fax:301-552-7975
Is Sole Proprietor?:No
Enumeration Date:2006-04-13
Last Update Date:2014-06-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD15168225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist