Healthcare Provider Details

I. General information

NPI: 1497171995
Provider Name (Legal Business Name): CAROLINA MACQUARRIE PT, ATC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/10/2014
Last Update Date: 08/10/2026
Certification Date: 08/10/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

345 ELM ST
BENNINGTON VT
05201-2265
US

IV. Provider business mailing address

109 ADAMS RD
WILLIAMSTOWN MA
01267-2930
US

V. Phone/Fax

Practice location:
  • Phone: 802-753-7930
  • Fax: 802-753-7924
Mailing address:
  • Phone: 413-664-1186
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2255A2300X
TaxonomyAthletic Trainer
License NumberATL3625
License Number StateMA
# 2
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number0400135088
License Number StateVT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: