Provider Demographics
NPI:1639302805
Name:WASMUCKY, CAROL (PT)
Entity Type:Individual
Prefix:
First Name:CAROL
Middle Name:
Last Name:WASMUCKY
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 1:9900 MAIN ST
Mailing Address - Street 2:SUITE 200A
Mailing Address - City:FAIRFAX
Mailing Address - State:VA
Mailing Address - Zip Code:22031-3907
Mailing Address - Country:US
Mailing Address - Phone:703-279-4249
Mailing Address - Fax:703-279-4271
Practice Address - Street 1:20905 PROFESSIONAL PLZ
Practice Address - Street 2:SUITE 110
Practice Address - City:ASHBURN
Practice Address - State:VA
Practice Address - Zip Code:20147-7783
Practice Address - Country:US
Practice Address - Phone:703-726-1616
Practice Address - Fax:703-726-1613
Is Sole Proprietor?:No
Enumeration Date:2009-09-03
Last Update Date:2009-09-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA2305003343225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist