Provider Demographics
NPI:1134643950
Name:CARROLL, IRIS ECHAVEZ
Entity Type:Individual
Prefix:
First Name:IRIS
Middle Name:ECHAVEZ
Last Name:CARROLL
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:809 COLUMBIA HWY
Mailing Address - Street 2:
Mailing Address - City:HOHENWALD
Mailing Address - State:TN
Mailing Address - Zip Code:38462-2406
Mailing Address - Country:US
Mailing Address - Phone:931-628-4805
Mailing Address - Fax:
Practice Address - Street 1:809 COLUMBIA HWY
Practice Address - Street 2:
Practice Address - City:HOHENWALD
Practice Address - State:TN
Practice Address - Zip Code:38462-2406
Practice Address - Country:US
Practice Address - Phone:931-628-4805
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-08-02
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNPTA5605225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant