Provider Demographics
NPI:1205671229
Name:CARRIE COTHRAN LLC
Entity type:Organization
Organization Name:CARRIE COTHRAN LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:CARRIE
Authorized Official - Middle Name:
Authorized Official - Last Name:COTHRAN
Authorized Official - Suffix:
Authorized Official - Credentials:DPT
Authorized Official - Phone:864-431-7580
Mailing Address - Street 1:11302 PALISADES CT
Mailing Address - Street 2:
Mailing Address - City:KENSINGTON
Mailing Address - State:MD
Mailing Address - Zip Code:20895-1334
Mailing Address - Country:US
Mailing Address - Phone:864-431-7580
Mailing Address - Fax:301-576-4560
Practice Address - Street 1:11302 PALISADES CT
Practice Address - Street 2:
Practice Address - City:KENSINGTON
Practice Address - State:MD
Practice Address - Zip Code:20895-1334
Practice Address - Country:US
Practice Address - Phone:864-431-7580
Practice Address - Fax:301-576-4560
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-07-01
Last Update Date:2024-07-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC1619181252Other225100000X