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General NPI Number Information
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NPI Number | 1972497147
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Entity Type | Individual
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Provider Name | CATHERINE CARROLL PT
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Gender | Female
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Dates
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Enumeration Date | 06/04/2025
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Last Update Date | 06/04/2025
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Provider Practice Location Address
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Address Line | 12400 PORTLAND AVE STE 140
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City | BURNSVILLE
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State | MN
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Zip | 55337-6805
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Country | US
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Telephone | 952-428-0400
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Fax |
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Provider Business Mailing Address
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Address Line | 8055 PENN AVE S APT 715
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City | BLOOMINGTON
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State | MN
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Zip | 55431-1391
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Country | US
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Telephone | 763-656-9280
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Fax |
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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 | 13850
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License Number State | MN
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