Provider Demographics
NPI:1013102045
Name:CARTY, CAROLYN M (PT)
Entity Type:Individual
Prefix:
First Name:CAROLYN
Middle Name:M
Last Name:CARTY
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:PO BOX 7848
Mailing Address - Street 2:
Mailing Address - City:PORTSMOUTH
Mailing Address - State:VA
Mailing Address - Zip Code:23707-0848
Mailing Address - Country:US
Mailing Address - Phone:757-398-0853
Mailing Address - Fax:757-398-0030
Practice Address - Street 1:2012 MEADE PKWY
Practice Address - Street 2:
Practice Address - City:SUFFOLK
Practice Address - State:VA
Practice Address - Zip Code:23434-4259
Practice Address - Country:US
Practice Address - Phone:757-934-3366
Practice Address - Fax:757-539-2322
Is Sole Proprietor?:No
Enumeration Date:2007-09-12
Last Update Date:2008-08-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA2305001984225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA015831O04Medicare PIN