Provider Demographics
NPI:1790289239
Name:MEROLA, KARLA ASTRID (LPTA)
Entity Type:Individual
Prefix:
First Name:KARLA
Middle Name:ASTRID
Last Name:MEROLA
Suffix:
Gender:F
Credentials:LPTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1343 BUTTER CHURN DR
Mailing Address - Street 2:
Mailing Address - City:HERNDON
Mailing Address - State:VA
Mailing Address - Zip Code:20170-2013
Mailing Address - Country:US
Mailing Address - Phone:703-201-2009
Mailing Address - Fax:
Practice Address - Street 1:9229 ARLINGTON BLVD
Practice Address - Street 2:
Practice Address - City:FAIRFAX
Practice Address - State:VA
Practice Address - Zip Code:22031-2504
Practice Address - Country:US
Practice Address - Phone:703-201-2009
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-03-20
Last Update Date:2018-03-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA2306604594225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant