Provider Demographics
NPI:1417164948
Name:CARROLL, MELISSA ERIN (PT)
Entity Type:Individual
Prefix:
First Name:MELISSA
Middle Name:ERIN
Last Name:CARROLL
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:MELISSA
Other - Middle Name:
Other - Last Name:MCSWEENEY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:156 GARDEN ST
Mailing Address - Street 2:
Mailing Address - City:LAWRENCE
Mailing Address - State:MA
Mailing Address - Zip Code:01840-1628
Mailing Address - Country:US
Mailing Address - Phone:978-902-2121
Mailing Address - Fax:
Practice Address - Street 1:126 MERRIMACK ST
Practice Address - Street 2:
Practice Address - City:METHUEN
Practice Address - State:MA
Practice Address - Zip Code:01844-6109
Practice Address - Country:US
Practice Address - Phone:978-681-0323
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-05-16
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA17666225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist