Provider Demographics
NPI:1134998362
Name:CARLEY, KATHRYN RAE (PT, DPT)
Entity type:Individual
Prefix:DR
First Name:KATHRYN
Middle Name:RAE
Last Name:CARLEY
Suffix:
Gender:F
Credentials:PT, DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5709 DORRINGTON CIR
Mailing Address - Street 2:
Mailing Address - City:GLEN ALLEN
Mailing Address - State:VA
Mailing Address - Zip Code:23059-7020
Mailing Address - Country:US
Mailing Address - Phone:804-754-6945
Mailing Address - Fax:
Practice Address - Street 1:7600 AUTUMN PARK WAY
Practice Address - Street 2:
Practice Address - City:MECHANICSVILLE
Practice Address - State:VA
Practice Address - Zip Code:23116-3868
Practice Address - Country:US
Practice Address - Phone:804-730-0009
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-12-28
Last Update Date:2024-02-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA2305216222225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist