Provider Demographics
NPI:1629300264
Name:CARROLL, ANTHONY (PT, DPT, CSCS)
Entity Type:Individual
Prefix:DR
First Name:ANTHONY
Middle Name:
Last Name:CARROLL
Suffix:
Gender:M
Credentials:PT, DPT, CSCS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:052 MCKINLY LAB
Mailing Address - Street 2:
Mailing Address - City:NEWARK
Mailing Address - State:DE
Mailing Address - Zip Code:19716
Mailing Address - Country:US
Mailing Address - Phone:302-831-8893
Mailing Address - Fax:
Practice Address - Street 1:063 EAST DELAWARE AVE
Practice Address - Street 2:053 MCKINLY LAB
Practice Address - City:NEWARK
Practice Address - State:DE
Practice Address - Zip Code:19716
Practice Address - Country:US
Practice Address - Phone:302-831-8893
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-02-08
Last Update Date:2010-02-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DEJ1-0002558208100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & Rehabilitation