Provider Demographics
NPI:1700202454
Name:WALKER, CARLENE (PT)
Entity Type:Individual
Prefix:
First Name:CARLENE
Middle Name:
Last Name:WALKER
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 1:100 CARPENTER DR STE 140
Mailing Address - Street 2:
Mailing Address - City:STERLING
Mailing Address - State:VA
Mailing Address - Zip Code:20164-4464
Mailing Address - Country:US
Mailing Address - Phone:703-707-9060
Mailing Address - Fax:703-707-9022
Practice Address - Street 1:100 CARPENTER DR STE 140
Practice Address - Street 2:
Practice Address - City:STERLING
Practice Address - State:VA
Practice Address - Zip Code:20164-4464
Practice Address - Country:US
Practice Address - Phone:703-707-9060
Practice Address - Fax:703-707-9022
Is Sole Proprietor?:No
Enumeration Date:2014-03-05
Last Update Date:2023-01-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA23052085522251P0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2251P0200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistPediatrics