Provider Demographics
NPI:1659861904
Name:CARTER, CALLIE A (PT, DPT)
Entity Type:Individual
Prefix:
First Name:CALLIE
Middle Name:A
Last Name:CARTER
Suffix:
Gender:F
Credentials:PT, DPT
Other - Prefix:
Other - First Name:CALLIE
Other - Middle Name:
Other - Last Name:ALVIS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:350 NEW FIDELITY CT
Mailing Address - Street 2:
Mailing Address - City:GARNER
Mailing Address - State:NC
Mailing Address - Zip Code:27529-2665
Mailing Address - Country:US
Mailing Address - Phone:757-873-2302
Mailing Address - Fax:757-873-2306
Practice Address - Street 1:44 BROAD STREET RD
Practice Address - Street 2:
Practice Address - City:MANAKIN SABOT
Practice Address - State:VA
Practice Address - Zip Code:23103
Practice Address - Country:US
Practice Address - Phone:804-784-7090
Practice Address - Fax:804-784-7092
Is Sole Proprietor?:No
Enumeration Date:2018-05-12
Last Update Date:2023-02-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA2305211886225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist