Provider Demographics
NPI:1518151711
Name:CARROLL, LINDA LEE (PTA)
Entity Type:Individual
Prefix:
First Name:LINDA
Middle Name:LEE
Last Name:CARROLL
Suffix:
Gender:F
Credentials:PTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:334 MAIN STREET
Mailing Address - Street 2:P.O. BOX 92
Mailing Address - City:WAMPUM
Mailing Address - State:PA
Mailing Address - Zip Code:16157
Mailing Address - Country:US
Mailing Address - Phone:724-674-8646
Mailing Address - Fax:
Practice Address - Street 1:257 GEORGETOWN RD
Practice Address - Street 2:
Practice Address - City:BEAVER FALLS
Practice Address - State:PA
Practice Address - Zip Code:15010-9740
Practice Address - Country:US
Practice Address - Phone:724-846-8200
Practice Address - Fax:724-847-2998
Is Sole Proprietor?:Yes
Enumeration Date:2007-08-30
Last Update Date:2013-11-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PATE007201225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant