Provider Demographics
NPI:1467638734
Name:CARROLL, RITCHIE MICHAEL (PT)
Entity Type:Individual
Prefix:MR
First Name:RITCHIE
Middle Name:MICHAEL
Last Name:CARROLL
Suffix:
Gender:M
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:210 S SHORE RD
Mailing Address - Street 2:SUITE 203
Mailing Address - City:MARMORA
Mailing Address - State:NJ
Mailing Address - Zip Code:08223-1200
Mailing Address - Country:US
Mailing Address - Phone:609-390-2400
Mailing Address - Fax:609-390-9587
Practice Address - Street 1:210 S SHORE RD
Practice Address - Street 2:SUITE 203
Practice Address - City:MARMORA
Practice Address - State:NJ
Practice Address - Zip Code:08223-1200
Practice Address - Country:US
Practice Address - Phone:609-390-2400
Practice Address - Fax:609-390-9587
Is Sole Proprietor?:No
Enumeration Date:2008-01-16
Last Update Date:2008-01-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ40QA00798200225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist