Provider Demographics
NPI:1750335071
Name:CARROLL PHYSICAL THERAPY
Entity type:Organization
Organization Name:CARROLL PHYSICAL THERAPY
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER/PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:JOSEPH
Authorized Official - Middle Name:P
Authorized Official - Last Name:CARROLL
Authorized Official - Suffix:
Authorized Official - Credentials:MSPT
Authorized Official - Phone:508-477-4800
Mailing Address - Street 1:168 INDUSTRIAL DR
Mailing Address - Street 2:UNIT 5
Mailing Address - City:MASHPEE
Mailing Address - State:MA
Mailing Address - Zip Code:02649-3561
Mailing Address - Country:US
Mailing Address - Phone:508-477-4800
Mailing Address - Fax:508-477-5377
Practice Address - Street 1:168 INDUSTRIAL DR
Practice Address - Street 2:UNIT 5
Practice Address - City:MASHPEE
Practice Address - State:MA
Practice Address - Zip Code:02649-3561
Practice Address - Country:US
Practice Address - Phone:508-477-4800
Practice Address - Fax:508-477-5377
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-20
Last Update Date:2016-05-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA4777225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA9728431Medicaid
MA9728431Medicaid