Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225100000X | Physical Therapist | 2305206507 | VA |
N | 2251X0800X | Physical Therapist - Orthopedic | 2305206507 | VA |
NPI | 1023691029 |
---|---|
Provider Name | Sara Carleton |
First Address | Front Royal, VA 22630-6777 |
Second Address | Front Royal, VA 22630-6777 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 28/04/2021 |
Last Update Date | 28/04/2021 |