Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 2251N0400X | Physical Therapist - Neurology | VA |
NPI | 1497891758 |
---|---|
Provider Name | Ms. Gwendolyn Louise Carr |
First Address | Chesapeake, VA 23322-8372 |
Second Address | Chesapeake, VA 23322-8372 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 30/01/2007 |
Last Update Date | 08/07/2007 |