1013035104 NPI number — CARROLL PHYSICAL THERAPY, INC.

Table of content: (NPI 1013035104)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1013035104 NPI number — CARROLL PHYSICAL THERAPY, INC.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
CARROLL PHYSICAL THERAPY, INC.
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1013035104
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
08/22/2020
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
9465 SEDGEWOOD DR
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
LAKE WORTH
Provider Business Mailing Address State Name:
FL
Provider Business Mailing Address Postal Code:
33467-6993
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
561-255-7444
Provider Business Mailing Address Fax Number:
561-966-5887

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
9073 S.E. BRIDGE R.D.
Provider Second Line Business Practice Location Address:
SUITE E
Provider Business Practice Location Address City Name:
HOBE SOUND
Provider Business Practice Location Address State Name:
FL
Provider Business Practice Location Address Postal Code:
33455-7941
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
561-255-7444
Provider Business Practice Location Address Fax Number:
561-966-5887
Provider Enumeration Date:
03/27/2007

Additional Information

Authorized Official

Authorized Official Last Name:
CARROLL
Authorized Official First Name:
TERANCE
Authorized Official Middle Name:
DEAN
Authorized Official Title or Position:
PRESIDENT
Authorized Official Telephone Number:
561-255-7444

Provider Taxonomy Codes

  • Taxonomy code: 225100000X , with the licence number:  PT19437 , registered in the state of FL ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





Copyright © 2007-2025 www.npivalidator.com