MEDICARE: MR. TERANCE DEAN CARROLL P.T.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	225100000X	Physical Therapist	PT19437	FL

General Provider Information

NPI Number	:	1386762466
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. TERANCE DEAN CARROLL P.T.

Provider Business Mailing Address
First Line	:	9465 SEDGEWOOD DR
Second Line	:
City	:	LAKE WORTH
State	:	FL
Zip	:	33467-6993
Country	:	US
Telephone Number	:	561-255-7444
Fax Number	:	561-966-5887

Provider Business Practice Location Address
First Line	:	4777 N CONGRESS AVE
Second Line	:
City	:	BOYNTON BEACH
State	:	FL
Zip	:	33426-7941
Country	:	US
Telephone Number	:	561-255-7444
Fax Number	:	561-966-5887

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	03/27/2007
Last Update Date	:	07/09/2007

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