Individual
ETHAN LANE CARROLL
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Contact information
Practice address
6858 OLD DOMINION DR STE 200, MC LEAN, VA 22101-3832
(703) 288-8260
Mailing address
8496 CANYON OAK DR, SPRINGFIELD, VA 22153-3576
(540) 327-6188
Taxonomy
Speciality
Code
Description
License number
State
225200000X
Physical Therapy Assistant
Primary
2306605698
VA
Other
Enumeration date
03/04/2021
Last updated
03/04/2021
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