Provider Demographics
NPI:1427505445
Name:ENDORF, CARSON SCOTT (DPT)
Entity type:Individual
Prefix:
First Name:CARSON
Middle Name:SCOTT
Last Name:ENDORF
Suffix:
Gender:F
Credentials:DPT
Other - Prefix:
Other - First Name:MARGARET
Other - Middle Name:CARSON
Other - Last Name:SCOTT
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DPT
Mailing Address - Street 1:1100 CIRCLE 75 PKWY SE STE 1400
Mailing Address - Street 2:
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30339-3067
Mailing Address - Country:US
Mailing Address - Phone:678-981-3543
Mailing Address - Fax:404-777-1311
Practice Address - Street 1:10260 MAIN ST STE 1400
Practice Address - Street 2:
Practice Address - City:FAIRFAX
Practice Address - State:VA
Practice Address - Zip Code:22030-2404
Practice Address - Country:US
Practice Address - Phone:571-279-6844
Practice Address - Fax:703-991-8141
Is Sole Proprietor?:No
Enumeration Date:2016-09-07
Last Update Date:2021-02-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA2305211231225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist