MEDICARE: CHRISTINA CARROLL ATC

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	2255A2300X	Athletic Trainer	RT004440	PA

General Provider Information

NPI Number	:	1184957631
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	CHRISTINA CARROLL ATC

Provider Business Mailing Address
First Line	:	2804 AUDUBON VILLAGE DR
Second Line	:
City	:	NORRISTOWN
State	:	PA
Zip	:	19403-2262
Country	:	US
Telephone Number	:	610-676-0411
Fax Number	:	610-676-0412

Provider Business Practice Location Address
First Line	:	2804 AUDUBON VILLAGE DR
Second Line	:
City	:	NORRISTOWN
State	:	PA
Zip	:	19403-2262
Country	:	US
Telephone Number	:	610-676-0411
Fax Number	:	610-676-0412

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

Provider Enumeration Date	:	09/16/2009
Last Update Date	:	09/16/2009

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Directions to “ CHRISTINA CARROLL ATC” Practice Location

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