Provider Demographics
NPI:1356462527
Name:CARROLL, MICHELIN SORTOR (PT, ATC)
Entity Type:Individual
Prefix:
First Name:MICHELIN
Middle Name:SORTOR
Last Name:CARROLL
Suffix:
Gender:F
Credentials:PT, ATC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:277 BLAIR PARK ROAD
Mailing Address - Street 2:SUITE 110
Mailing Address - City:WILLISTON
Mailing Address - State:VT
Mailing Address - Zip Code:05495
Mailing Address - Country:US
Mailing Address - Phone:802-878-3600
Mailing Address - Fax:802-879-3041
Practice Address - Street 1:277 BLAIR PARK ROAD
Practice Address - Street 2:SUITE 110
Practice Address - City:WILLISTON
Practice Address - State:VT
Practice Address - Zip Code:05495
Practice Address - Country:US
Practice Address - Phone:802-878-3600
Practice Address - Fax:802-879-3041
Is Sole Proprietor?:No
Enumeration Date:2007-04-03
Last Update Date:2013-04-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VT040-0002722225100000X
VT040.0002722225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist