Provider Demographics
NPI:1568126092
Name:CERAR, KARYN (LMT, BCMT)
Entity Type:Individual
Prefix:
First Name:KARYN
Middle Name:
Last Name:CERAR
Suffix:
Gender:F
Credentials:LMT, BCMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11209 KENSINGTON PL
Mailing Address - Street 2:
Mailing Address - City:FREDERICKSBURG
Mailing Address - State:VA
Mailing Address - Zip Code:22407-7630
Mailing Address - Country:US
Mailing Address - Phone:267-973-0299
Mailing Address - Fax:
Practice Address - Street 1:311 FREDERICK ST
Practice Address - Street 2:
Practice Address - City:FREDERICKSBURG
Practice Address - State:VA
Practice Address - Zip Code:22401-6025
Practice Address - Country:US
Practice Address - Phone:540-840-4144
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-10-30
Last Update Date:2021-10-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0019012785225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist