Provider Demographics
NPI:1285956763
Name:MURRAY, CARLY (DPT)
Entity type:Individual
Prefix:
First Name:CARLY
Middle Name:
Last Name:MURRAY
Suffix:
Gender:F
Credentials:DPT
Other - Prefix:
Other - First Name:CARLY
Other - Middle Name:
Other - Last Name:GERONIMO
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DPT
Mailing Address - Street 1:2224 VIRGINIA BEACH BLVD
Mailing Address - Street 2:SUITE 106
Mailing Address - City:VIRGINIA BEACH
Mailing Address - State:VA
Mailing Address - Zip Code:23454-4285
Mailing Address - Country:US
Mailing Address - Phone:757-486-8663
Mailing Address - Fax:757-486-2650
Practice Address - Street 1:2224 VIRGINIA BEACH BLVD
Practice Address - Street 2:SUITE 106
Practice Address - City:VIRGINIA BEACH
Practice Address - State:VA
Practice Address - Zip Code:23454-4285
Practice Address - Country:US
Practice Address - Phone:757-486-8663
Practice Address - Fax:757-486-2650
Is Sole Proprietor?:No
Enumeration Date:2010-02-24
Last Update Date:2011-08-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA2305206370225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
P00901165OtherRAILROAD MEDICARE
P00901165OtherRAILROAD MEDICARE