Provider Demographics
NPI:1225181886
Name:CARTER, DAVID MATTHEW (MSPT)
Entity type:Individual
Prefix:
First Name:DAVID
Middle Name:MATTHEW
Last Name:CARTER
Suffix:
Gender:M
Credentials:MSPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 57
Mailing Address - Street 2:
Mailing Address - City:GOOCHLAND
Mailing Address - State:VA
Mailing Address - Zip Code:23063-0057
Mailing Address - Country:US
Mailing Address - Phone:804-247-1555
Mailing Address - Fax:
Practice Address - Street 1:1940 SANDY HOOK RD
Practice Address - Street 2:SUITE F
Practice Address - City:GOOCHLAND
Practice Address - State:VA
Practice Address - Zip Code:23063-3107
Practice Address - Country:US
Practice Address - Phone:804-556-7181
Practice Address - Fax:804-556-7182
Is Sole Proprietor?:No
Enumeration Date:2007-01-18
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA23050045592251X0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2251X0800XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistOrthopedic