Individual
MISS CARISSA ERIN WORTHAM
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
ATC
Contact information
Practice address
6564 LOISDALE CT STE 500, SPRINGFIELD, VA 22150-1823
(703) 232-7977
Mailing address
17872 LOUNSBERY DR, DUMFRIES, VA 22026-2639
(703) 232-7977
Taxonomy
Speciality
Code
Description
License number
State
2255A2300X
Athletic Trainer
Primary
—
—
Other
Enumeration date
06/18/2022
Last updated
06/18/2022
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