ETHAN LANE CARROLL

MC LEAN, VA
NPI1548855141
Entity TypeIndividual
GenderMale
Sole Proprietor ?No
Primary Taxonomy225200000X Physical Therapy Assistant
(Licence: VA  2306605698)
Enumeration Date2021-03-04
Last Update Date2021-03-04
Business Address
ETHAN LANE CARROLL
6858 OLD DOMINION DR STE 200
MC LEAN, VA 22101-3832
Phone number: 703-288-8260
Mailing Address
ETHAN LANE CARROLL
8496 CANYON OAK DR
SPRINGFIELD, VA 22153-3576
Phone number: 540-327-6188
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