Provider Demographics
NPI:1437395506
Name:CARROLL, MARY JANA (PT)
Entity Type:Individual
Prefix:MRS
First Name:MARY
Middle Name:JANA
Last Name:CARROLL
Suffix:
Gender:F
Credentials:PT
Other - Prefix:MRS
Other - First Name:JANA
Other - Middle Name:K
Other - Last Name:CARROLL
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:PT
Mailing Address - Street 1:2048A S BROAD ST
Mailing Address - Street 2:BROOKLEY COMPLEX
Mailing Address - City:MOBILE
Mailing Address - State:AL
Mailing Address - Zip Code:36615-1285
Mailing Address - Country:US
Mailing Address - Phone:251-433-1414
Mailing Address - Fax:251-433-9634
Practice Address - Street 1:2048A S BROAD ST
Practice Address - Street 2:BROOKLEY COMPLEX
Practice Address - City:MOBILE
Practice Address - State:AL
Practice Address - Zip Code:36615-1285
Practice Address - Country:US
Practice Address - Phone:251-433-1414
Practice Address - Fax:251-433-9634
Is Sole Proprietor?:No
Enumeration Date:2008-12-19
Last Update Date:2009-02-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL2105225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL51048200OtherBLUE CROSS
AL07327Medicare UPIN