Ethan Lane Carroll

Primary specialty

Physical Therapy AssistantTaxonomy code 225200000X

License

2306605698 Issued in VA

Practice address

6858 Old Dominion Dr Ste 200
MC Lean, VA 22101-3832

Phone

(703) 288-8260

NPI assigned

Mar 4, 2021

Sex

Male

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1614816000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1614816000000",
    "number": "1548855141",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "8496 CANYON OAK DR",
            "city": "SPRINGFIELD",
            "state": "VA",
            "postal_code": "221533576",
            "telephone_number": "540-327-6188"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "6858 OLD DOMINION DR STE 200",
            "city": "MC LEAN",
            "state": "VA",
            "postal_code": "221013832",
            "telephone_number": "703-288-8260"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "CARROLL",
        "first_name": "ETHAN",
        "middle_name": "LANE",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2021-03-04",
        "last_updated": "2021-03-04",
        "certification_date": "2021-03-04",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "225200000X",
            "taxonomy_group": "",
            "desc": "Physical Therapy Assistant",
            "state": "VA",
            "license": "2306605698",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Carevana Home Health Inc.
• Alison Cariello, LPC, SEP
• Jeanine Ruth Carlson, PH.D.
• Jennifer Maskell Carney, PH.D.
• Lillian Carol Carpio, D.D.S., M.S., PH.D.
• Shamari Carroll, PT, DPT
• Tajha Carroll, FNP
• Carte Medical Ca, PC
• Amanda C Carter
• Suzanne B Casana, NP

• Physical Therapy Assistant in McLean, VA
• Providers in McLean, VA by specialty
• Physical Therapy Assistant in Virginia

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 4, 2021; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.