MEDICARE: CAROLYN CARROLL PT

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	1421	SC

General Provider Information

NPI Number	:	1518188267
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	CAROLYN CARROLL PT

Provider Business Mailing Address
First Line	:	312 GRAY FOX SQ
Second Line	:
City	:	TAYLORS
State	:	SC
Zip	:	29687-4000
Country	:	US
Telephone Number	:	864-292-0094
Fax Number	:

Provider Business Practice Location Address
First Line	:	205 MILLERSPRINGS CT
Second Line	:
City	:	FRANKLIN
State	:	TN
Zip	:	37064-5434
Country	:	US
Telephone Number	:	864-989-5540
Fax Number	:

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

Provider Enumeration Date	:	05/01/2007
Last Update Date	:	09/25/2012

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