MEDICARE: BRIANNA FELICE CARROLL

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		TX

General Provider Information

NPI Number	:	1710715164
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	BRIANNA FELICE CARROLL

Provider Business Mailing Address
First Line	:	790 REMINGTON BLVD
Second Line	:
City	:	BOLINGBROOK
State	:	IL
Zip	:	60440-4909
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	14999 PRESTON RD STE 108C
Second Line	:
City	:	DALLAS
State	:	TX
Zip	:	75254-9138
Country	:	US
Telephone Number	:	214-231-4154
Fax Number	:	469-672-5520

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

Provider Enumeration Date	:	07/25/2024
Last Update Date	:	07/25/2024

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Directions to “ BRIANNA FELICE CARROLL ” Practice Location

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