Provider Demographics
NPI:1750765731
Name:WALL, CARRIE TEMPLE (DPT, PT)
Entity type:Individual
Prefix:DR
First Name:CARRIE
Middle Name:TEMPLE
Last Name:WALL
Suffix:
Gender:F
Credentials:DPT, PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6733 CURRAN ST
Mailing Address - Street 2:100
Mailing Address - City:MC LEAN
Mailing Address - State:VA
Mailing Address - Zip Code:22101-6005
Mailing Address - Country:US
Mailing Address - Phone:703-448-0259
Mailing Address - Fax:
Practice Address - Street 1:6733 CURRAN ST
Practice Address - Street 2:100
Practice Address - City:MC LEAN
Practice Address - State:VA
Practice Address - Zip Code:22101-6005
Practice Address - Country:US
Practice Address - Phone:703-448-0259
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-07-19
Last Update Date:2015-07-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA23052091542251X0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2251X0800XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistOrthopedic