Provider Demographics
NPI:1316114796
Name:CHAMBERLAIN, CARRIE L (PT, DPT)
Entity type:Individual
Prefix:
First Name:CARRIE
Middle Name:L
Last Name:CHAMBERLAIN
Suffix:
Gender:F
Credentials:PT, DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:771 PILOT HOUSE DR
Mailing Address - Street 2:
Mailing Address - City:NEWPORT NEWS
Mailing Address - State:VA
Mailing Address - Zip Code:23606-1990
Mailing Address - Country:US
Mailing Address - Phone:757-873-2302
Mailing Address - Fax:757-873-2306
Practice Address - Street 1:300B TEMPLE LAKE DR
Practice Address - Street 2:SUITE 1
Practice Address - City:COLONIAL HEIGHTS
Practice Address - State:VA
Practice Address - Zip Code:23834-2973
Practice Address - Country:US
Practice Address - Phone:804-524-9036
Practice Address - Fax:804-524-9039
Is Sole Proprietor?:No
Enumeration Date:2008-05-14
Last Update Date:2011-01-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA2305204388225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA1316114796Medicaid
VAP00608798OtherRAILROAD MEDICARE
VA192946OtherBCBS (PHYSICAL THERAPY)
VA9261158OtherAETNA
VAP00608798OtherRAILROAD MEDICARE
VA192946OtherBCBS (PHYSICAL THERAPY)