Provider Demographics
NPI:1780818708
Name:CARROLL, RAYMOND III (PT)
Entity Type:Individual
Prefix:MR
First Name:RAYMOND
Middle Name:
Last Name:CARROLL
Suffix:III
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 1:14 WOODRUFF AVE
Mailing Address - Street 2:SUITE 7
Mailing Address - City:NARRAGANSETT
Mailing Address - State:RI
Mailing Address - Zip Code:02882-3467
Mailing Address - Country:US
Mailing Address - Phone:401-782-0500
Mailing Address - Fax:401-788-2253
Practice Address - Street 1:14 WOODRUFF AVE
Practice Address - Street 2:SUITE 7
Practice Address - City:NARRAGANSETT
Practice Address - State:RI
Practice Address - Zip Code:02882-3467
Practice Address - Country:US
Practice Address - Phone:401-782-0500
Practice Address - Fax:401-788-2253
Is Sole Proprietor?:No
Enumeration Date:2009-05-05
Last Update Date:2009-05-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
RI01397225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist