Provider Demographics
NPI:1013295781
Name:CARNAHAN, RENEE DIANE (MS PT)
Entity Type:Individual
Prefix:MRS
First Name:RENEE
Middle Name:DIANE
Last Name:CARNAHAN
Suffix:
Gender:F
Credentials:MS PT
Other - Prefix:
Other - First Name:RENEE
Other - Middle Name:DIANE
Other - Last Name:CLINE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:7115 LEESBURG PIKE
Mailing Address - Street 2:SUITE #305
Mailing Address - City:FALLS CHURCH
Mailing Address - State:VA
Mailing Address - Zip Code:22043-2367
Mailing Address - Country:US
Mailing Address - Phone:703-533-1515
Mailing Address - Fax:703-894-4916
Practice Address - Street 1:7115 LEESBURG PIKE
Practice Address - Street 2:SUITE #305
Practice Address - City:FALLS CHURCH
Practice Address - State:VA
Practice Address - Zip Code:22043-2367
Practice Address - Country:US
Practice Address - Phone:703-533-1515
Practice Address - Fax:703-894-4916
Is Sole Proprietor?:No
Enumeration Date:2011-07-29
Last Update Date:2011-07-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA2305831298225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA2305831298OtherCOMMONWEALTH OF VIRGINIA BOARD OF PHYSICAL THERAPY