Provider Demographics
NPI:1750012969
Name:CARROLL PHYSIOTHERAPY
Entity Type:Organization
Organization Name:CARROLL PHYSIOTHERAPY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:KYLE
Authorized Official - Middle Name:EMMETT
Authorized Official - Last Name:CARROLL
Authorized Official - Suffix:
Authorized Official - Credentials:PT, DPT
Authorized Official - Phone:602-456-2153
Mailing Address - Street 1:2200 E CAMELBACK RD STE 102
Mailing Address - Street 2:
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85016-3455
Mailing Address - Country:US
Mailing Address - Phone:602-456-2153
Mailing Address - Fax:
Practice Address - Street 1:2200 E CAMELBACK RD STE 102
Practice Address - Street 2:
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85016-3455
Practice Address - Country:US
Practice Address - Phone:602-456-2153
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-06-19
Last Update Date:2023-09-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2000XAmbulatory Health Care FacilitiesClinic/CenterPhysical Therapy