Provider Demographics
NPI:1568552925
Name:CAROUSEL PHYSICAL THERAPY, INC.
Entity Type:Organization
Organization Name:CAROUSEL PHYSICAL THERAPY, INC.
Other - Org Name:CAROUSEL PHYSICAL THERAPY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT/ PHYSICAL THERAPIST
Authorized Official - Prefix:MRS
Authorized Official - First Name:VICKI
Authorized Official - Middle Name:L
Authorized Official - Last Name:VERMEER
Authorized Official - Suffix:
Authorized Official - Credentials:MSPT
Authorized Official - Phone:804-435-3435
Mailing Address - Street 1:500 IRVINGTON ROAD
Mailing Address - Street 2:P.O. BOX 128
Mailing Address - City:KILMARNOCK
Mailing Address - State:VA
Mailing Address - Zip Code:22482
Mailing Address - Country:US
Mailing Address - Phone:804-435-3435
Mailing Address - Fax:
Practice Address - Street 1:500 IRVINGTON ROAD
Practice Address - Street 2:
Practice Address - City:KILMARNOCK
Practice Address - State:VA
Practice Address - Zip Code:22482
Practice Address - Country:US
Practice Address - Phone:804-435-3435
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-13
Last Update Date:2019-07-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA2305202045174400000X
261QP2000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Multi-Specialty
No261QP2000XAmbulatory Health Care FacilitiesClinic/CenterPhysical TherapyGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA20091OtherSENTARA
VA009402331Medicaid
GACH0505OtherRAILROAD MEDICARE
VA194072OtherANTHEM BC & BS
VA=========OtherCOMMERCIAL/WC CARRIER