Provider Demographics
NPI:1043287386
Name:CARROLL, CHRISTY RUDELLE (PT)
Entity Type:Individual
Prefix:
First Name:CHRISTY
Middle Name:RUDELLE
Last Name:CARROLL
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:500 N UNION ST
Mailing Address - Street 2:
Mailing Address - City:MIDDLETOWN
Mailing Address - State:PA
Mailing Address - Zip Code:17057-1950
Mailing Address - Country:US
Mailing Address - Phone:717-944-2225
Mailing Address - Fax:717-944-0932
Practice Address - Street 1:500 N UNION ST
Practice Address - Street 2:
Practice Address - City:MIDDLETOWN
Practice Address - State:PA
Practice Address - Zip Code:17057-1950
Practice Address - Country:US
Practice Address - Phone:717-944-2225
Practice Address - Fax:717-944-0932
Is Sole Proprietor?:No
Enumeration Date:2006-03-07
Last Update Date:2016-06-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAPT015716225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA1432345OtherHIGHMARK
PA50000936OtherCBC
065557LKKMedicare ID - Type Unspecified