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General NPI Number Information
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NPI Number | 1871053397
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Entity Type | Individual
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Provider Name | ANDREW CARRELL PT, DPT, CSCS
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Gender | Male
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Dates
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Enumeration Date | 03/21/2019
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Last Update Date | 03/02/2020
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Provider Practice Location Address
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Address Line | 1565 SAXON BLVD STE 301
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City | DELTONA
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State | FL
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Zip | 32725-5836
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Country | US
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Telephone | 386-851-0901
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Fax | 386-851-2426
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Provider Business Mailing Address
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Address Line | 336 BROAD ST STE 203
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City | ROME
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State | GA
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Zip | 30161-3006
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Country | US
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Telephone | 386-851-0901
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Fax | 386-851-2426
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 225100000X
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Taxonomy Name | Physical Therapist
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License Number | PT35622
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License Number State | FL
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Taxonomy #2
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Taxonomy Code | 208100000X
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Taxonomy Name | Physical Medicine & Rehabilitation Physician
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License Number | PT5431
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License Number State | NM
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