Provider Demographics
NPI:1013035104
Name:CARROLL PHYSICAL THERAPY, INC.
Entity Type:Organization
Organization Name:CARROLL PHYSICAL THERAPY, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:TERANCE
Authorized Official - Middle Name:DEAN
Authorized Official - Last Name:CARROLL
Authorized Official - Suffix:
Authorized Official - Credentials:PT
Authorized Official - Phone:561-255-7444
Mailing Address - Street 1:9465 SEDGEWOOD DR
Mailing Address - Street 2:
Mailing Address - City:LAKE WORTH
Mailing Address - State:FL
Mailing Address - Zip Code:33467-6993
Mailing Address - Country:US
Mailing Address - Phone:561-255-7444
Mailing Address - Fax:561-966-5887
Practice Address - Street 1:9073 S.E. BRIDGE R.D.
Practice Address - Street 2:SUITE E
Practice Address - City:HOBE SOUND
Practice Address - State:FL
Practice Address - Zip Code:33455-7941
Practice Address - Country:US
Practice Address - Phone:561-255-7444
Practice Address - Fax:561-966-5887
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-27
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPT19437225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Multi-Specialty