Provider Demographics
NPI:1750622502
Name:CARROLL, DOUGLAS STEPHEN (DPT)
Entity type:Individual
Prefix:MR
First Name:DOUGLAS
Middle Name:STEPHEN
Last Name:CARROLL
Suffix:
Gender:M
Credentials:DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:21 WEST GOLF VIEW RD.
Mailing Address - Street 2:
Mailing Address - City:HAVERTOWN
Mailing Address - State:PA
Mailing Address - Zip Code:19083-1101
Mailing Address - Country:US
Mailing Address - Phone:610-348-5525
Mailing Address - Fax:
Practice Address - Street 1:21 W GOLFVIEW RD
Practice Address - Street 2:
Practice Address - City:HAVERTOWN
Practice Address - State:PA
Practice Address - Zip Code:19083-1101
Practice Address - Country:US
Practice Address - Phone:610-348-5525
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-03-04
Last Update Date:2013-03-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAPT022568225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist