Provider Demographics
NPI:1881725166
Name:CARROLL, LOREN L (MSPT)
Entity type:Individual
Prefix:
First Name:LOREN
Middle Name:L
Last Name:CARROLL
Suffix:
Gender:F
Credentials:MSPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7662 DANUBE DR
Mailing Address - Street 2:
Mailing Address - City:HUNTINGTON BEACH
Mailing Address - State:CA
Mailing Address - Zip Code:92647-4639
Mailing Address - Country:US
Mailing Address - Phone:714-334-1014
Mailing Address - Fax:714-847-4866
Practice Address - Street 1:7662 DANUBE DR
Practice Address - Street 2:
Practice Address - City:HUNTINGTON BEACH
Practice Address - State:CA
Practice Address - Zip Code:92647-4639
Practice Address - Country:US
Practice Address - Phone:714-334-1014
Practice Address - Fax:209-780-4035
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-08
Last Update Date:2021-11-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPT18207225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAWPT18207CMedicare PIN