Provider Demographics
NPI:1992442404
Name:CARROLL, SHAMARI (PT, DPT)
Entity type:Individual
Prefix:DR
First Name:SHAMARI
Middle Name:
Last Name:CARROLL
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 1:2216 LAGUARD DR
Mailing Address - Street 2:
Mailing Address - City:HAMPTON
Mailing Address - State:VA
Mailing Address - Zip Code:23661-2416
Mailing Address - Country:US
Mailing Address - Phone:757-329-9764
Mailing Address - Fax:
Practice Address - Street 1:6733 CURRAN ST STE 100
Practice Address - Street 2:
Practice Address - City:MC LEAN
Practice Address - State:VA
Practice Address - Zip Code:22101-6032
Practice Address - Country:US
Practice Address - Phone:703-448-0259
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-05-16
Last Update Date:2022-05-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA2305214960225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist