MEDICARE: KATHRYN 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	4638	MA

General Provider Information

NPI Number	:	1740261361
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KATHRYN CARROLL PT

Provider Business Mailing Address
First Line	:	800 ROUTE 28
Second Line	:	SUMMERFIELD PARK
City	:	MASHPEE
State	:	MA
Zip	:	02649-3303
Country	:	US
Telephone Number	:	508-477-4800
Fax Number	:	508-477-5377

Provider Business Practice Location Address
First Line	:	800 ROUTE 28
Second Line	:	SUMMERFIELD PARK
City	:	MASHPEE
State	:	MA
Zip	:	02649-3303
Country	:	US
Telephone Number	:	508-477-4800
Fax Number	:	508-477-5377

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

Provider Enumeration Date	:	11/10/2005
Last Update Date	:	10/05/2011

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