Provider Demographics
NPI:1851380463
Name:BACKALL, KAREN A (PT)
Entity Type:Individual
Prefix:
First Name:KAREN
Middle Name:A
Last Name:BACKALL
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 1:112 N RIVER RD
Mailing Address - Street 2:
Mailing Address - City:BRIDGEWATER
Mailing Address - State:VA
Mailing Address - Zip Code:22812-1611
Mailing Address - Country:US
Mailing Address - Phone:540-828-6443
Mailing Address - Fax:540-828-6583
Practice Address - Street 1:111 CENTRAL PARK AVE STE E
Practice Address - Street 2:
Practice Address - City:PINEHURST
Practice Address - State:NC
Practice Address - Zip Code:28374-8805
Practice Address - Country:US
Practice Address - Phone:910-215-0541
Practice Address - Fax:910-215-9886
Is Sole Proprietor?:No
Enumeration Date:2005-10-17
Last Update Date:2007-10-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC2199174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC0775NOtherANTHEM PROVIDER NUMBER
NC2334264Medicare PIN