Provider Demographics
NPI:1588948137
Name:WHITMIRE, CAROL ANN (LAC, PT)
Entity type:Individual
Prefix:MISS
First Name:CAROL
Middle Name:ANN
Last Name:WHITMIRE
Suffix:
Gender:F
Credentials:LAC, PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1700 W. ABINGDON DR. # 301
Mailing Address - Street 2:
Mailing Address - City:ALEXANDRIA
Mailing Address - State:VA
Mailing Address - Zip Code:22314-1065
Mailing Address - Country:US
Mailing Address - Phone:202-746-3830
Mailing Address - Fax:
Practice Address - Street 1:2101 MT. VERNON AVE.
Practice Address - Street 2:
Practice Address - City:ALEXANDRIA
Practice Address - State:VA
Practice Address - Zip Code:22301
Practice Address - Country:US
Practice Address - Phone:703-706-9500
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-09-30
Last Update Date:2011-09-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0121000277171100000X
VA2305004854261QP2000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist
No261QP2000XAmbulatory Health Care FacilitiesClinic/CenterPhysical Therapy