Provider Demographics
NPI:1982749099
Name:CARROLL, DANIEL EDWARD (ATC)
Entity Type:Individual
Prefix:MR
First Name:DANIEL
Middle Name:EDWARD
Last Name:CARROLL
Suffix:
Gender:M
Credentials:ATC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5158 BOXWOOD DRIVE
Mailing Address - Street 2:
Mailing Address - City:MOUNT JACKSON
Mailing Address - State:VA
Mailing Address - Zip Code:22842-9528
Mailing Address - Country:US
Mailing Address - Phone:717-261-7543
Mailing Address - Fax:
Practice Address - Street 1:150 STONEWALL LANE
Practice Address - Street 2:
Practice Address - City:QUICKSBURG
Practice Address - State:VA
Practice Address - Zip Code:22847-1429
Practice Address - Country:US
Practice Address - Phone:540-975-0221
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-02-20
Last Update Date:2012-11-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA01260007272255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer