Basic Information
| Provider Information | |||||||||
| NPI: | 1851305148 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | SALYERS-CARROLL | ||||||||
| FirstName: | KERI | ||||||||
| MiddleName: | JEANNINE | ||||||||
| NamePrefix: | MRS. | ||||||||
| NameSuffix: | |||||||||
| Credential: | P.T. | ||||||||
| OtherOrganizationName: | |||||||||
| OtherOrganizationType: | |||||||||
| OtherLastName: | SALYERS | ||||||||
| OtherFirstName: | KERI | ||||||||
| OtherMiddleName: | JEANNINE | ||||||||
| OtherNamePrefix: | MS. | ||||||||
| OtherNameSuffix: | |||||||||
| OtherCredential: | P.T. | ||||||||
| OtherLastNameType: | 1 | ||||||||
| Mailing Information | |||||||||
| Address1: | 2003 PHILLIPS TER UNIT 6 | ||||||||
| Address2: | |||||||||
| City: | ANNAPOLIS | ||||||||
| State: | MD | ||||||||
| PostalCode: | 214018169 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4109561574 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | 3179 BRAVERTON ST | ||||||||
| Address2: | SUITE 201 | ||||||||
| City: | EDGEWATER | ||||||||
| State: | MD | ||||||||
| PostalCode: | 210372665 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4109564308 | ||||||||
| FaxNumber: | 4109568038 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 07/29/2006 | ||||||||
| LastUpdateDate: | 07/08/2007 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | |||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 225100000X | 20348 | MD | Y | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Physical Therapist |
ID Information
| ID | Type | State | Issuer | Description | 57731 | 01 | MD | JOHN HOPKINS HEALTHCARE | OTHER | 5622033 | 01 | MD | CCN NETWORK | OTHER | 699023 | 01 | MD | NCPPO | OTHER | T6710017 | 01 | MD | BLUECROSS BLUESHIELD DC | OTHER | 2431568 | 01 | MD | UNITED HEALTHCARE | OTHER | 756LL185 | 01 | MD | RAILROAD MEDICARE | OTHER | 619225-02 | 01 | MD | BLUECROSS BLUESHIELD MD | OTHER |