Provider Demographics
NPI:1912246778
Name:CARTER, ANNIE TERRELL (PTA)
Entity type:Individual
Prefix:
First Name:ANNIE
Middle Name:TERRELL
Last Name:CARTER
Suffix:
Gender:F
Credentials:PTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1117 MOUNTAIN RD
Mailing Address - Street 2:
Mailing Address - City:AFTON
Mailing Address - State:VA
Mailing Address - Zip Code:22920-5023
Mailing Address - Country:US
Mailing Address - Phone:540-471-7703
Mailing Address - Fax:
Practice Address - Street 1:330 CLAREMONT LN
Practice Address - Street 2:
Practice Address - City:CROZET
Practice Address - State:VA
Practice Address - Zip Code:22932-3386
Practice Address - Country:US
Practice Address - Phone:434-812-3077
Practice Address - Fax:434-823-7681
Is Sole Proprietor?:No
Enumeration Date:2013-02-13
Last Update Date:2014-05-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA2306601615225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant