Provider Demographics
NPI:1740261361
Name:CARROLL, KATHRYN (PT)
Entity type:Individual
Prefix:
First Name:KATHRYN
Middle Name:
Last Name:CARROLL
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:800 ROUTE 28
Mailing Address - Street 2:SUMMERFIELD PARK
Mailing Address - City:MASHPEE
Mailing Address - State:MA
Mailing Address - Zip Code:02649-3303
Mailing Address - Country:US
Mailing Address - Phone:508-477-4800
Mailing Address - Fax:508-477-5377
Practice Address - Street 1:800 ROUTE 28
Practice Address - Street 2:SUMMERFIELD PARK
Practice Address - City:MASHPEE
Practice Address - State:MA
Practice Address - Zip Code:02649-3303
Practice Address - Country:US
Practice Address - Phone:508-477-4800
Practice Address - Fax:508-477-5377
Is Sole Proprietor?:No
Enumeration Date:2005-11-10
Last Update Date:2011-10-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA4638225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MAY68288Medicare ID - Type Unspecified