Provider Demographics
NPI:1952397531
Name:HUSSEY, CAROLE R (DPT)
Entity Type:Individual
Prefix:DR
First Name:CAROLE
Middle Name:R
Last Name:HUSSEY
Suffix:
Gender:F
Credentials:DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:301 LAVINDER ST
Mailing Address - Street 2:
Mailing Address - City:MARTINSVILLE
Mailing Address - State:VA
Mailing Address - Zip Code:24112-3520
Mailing Address - Country:US
Mailing Address - Phone:276-632-5281
Mailing Address - Fax:276-632-6884
Practice Address - Street 1:301 LAVINDER ST
Practice Address - Street 2:
Practice Address - City:MARTINSVILLE
Practice Address - State:VA
Practice Address - Zip Code:24112-3520
Practice Address - Country:US
Practice Address - Phone:276-632-5281
Practice Address - Fax:276-632-6884
Is Sole Proprietor?:Yes
Enumeration Date:2005-09-20
Last Update Date:2015-10-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA2305003684225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA743117794OtherTRICARE
VA7654644OtherAETNA
VA743117794OtherGREAT WEST
VA743117794OtherMEDRISK
VA743117794OtherGREAT WEST