Provider Demographics
NPI:1841566726
Name:REED, CARISSA NICOLE (PT, DPT)
Entity type:Individual
Prefix:MRS
First Name:CARISSA
Middle Name:NICOLE
Last Name:REED
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 1:2130 PRIEST BRIDGE DR
Mailing Address - Street 2:STE 2
Mailing Address - City:CROFTON
Mailing Address - State:MD
Mailing Address - Zip Code:21114-2457
Mailing Address - Country:US
Mailing Address - Phone:410-535-9850
Mailing Address - Fax:410-535-9851
Practice Address - Street 1:2130 PRIEST BRIDGE DR STE 2
Practice Address - Street 2:
Practice Address - City:CROFTON
Practice Address - State:MD
Practice Address - Zip Code:21114-2457
Practice Address - Country:US
Practice Address - Phone:410-535-9850
Practice Address - Fax:410-535-9851
Is Sole Proprietor?:No
Enumeration Date:2012-03-26
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD23835225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist