Provider Demographics
NPI:1508952110
Name:CARROLL, DANIEL JOSEPH (PT, FAAOMPT)
Entity Type:Individual
Prefix:
First Name:DANIEL
Middle Name:JOSEPH
Last Name:CARROLL
Suffix:
Gender:M
Credentials:PT, FAAOMPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:31 COMANCHE AVE
Mailing Address - Street 2:
Mailing Address - City:ROCKAWAY
Mailing Address - State:NJ
Mailing Address - Zip Code:07866-1115
Mailing Address - Country:US
Mailing Address - Phone:201-572-3961
Mailing Address - Fax:
Practice Address - Street 1:30 VREELAND RD
Practice Address - Street 2:BUILDING A, SUITE 110
Practice Address - City:FLORHAM PARK
Practice Address - State:NJ
Practice Address - Zip Code:07932-1901
Practice Address - Country:US
Practice Address - Phone:973-660-1000
Practice Address - Fax:973-660-1008
Is Sole Proprietor?:No
Enumeration Date:2006-10-04
Last Update Date:2011-02-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ40QA01176700225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJQ67609Medicare UPIN