Provider Demographics
NPI:1720141138
Name:DICARLO, ELISSA (PT)
Entity Type:Individual
Prefix:
First Name:ELISSA
Middle Name:
Last Name:DICARLO
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 1:2021 K ST NW STE 500
Mailing Address - Street 2:SPORTS AND SPINAL PHYSICAL THERAPY
Mailing Address - City:WASHINGTON
Mailing Address - State:DC
Mailing Address - Zip Code:20006-1003
Mailing Address - Country:US
Mailing Address - Phone:202-736-7611
Mailing Address - Fax:301-736-7669
Practice Address - Street 1:2021 K ST NW STE 500
Practice Address - Street 2:SPORTS AND SPINAL PHYSICAL THERAPY
Practice Address - City:WASHINGTON
Practice Address - State:DC
Practice Address - Zip Code:20006-1003
Practice Address - Country:US
Practice Address - Phone:301-736-7611
Practice Address - Fax:301-736-7669
Is Sole Proprietor?:No
Enumeration Date:2006-12-18
Last Update Date:2008-10-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA4800225100000X
DCPT870882225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist