MEDICARE: KIERAN CARROLL

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

General Provider Information

NPI Number	:	1356871636
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KIERAN CARROLL

Provider Business Mailing Address
First Line	:	7421 S OUTER 364
Second Line	:	STE B
City	:	DARDENNE PRAIRIE
State	:	MO
Zip	:	63368-7014
Country	:	US
Telephone Number	:	636-561-2060
Fax Number	:	636-561-4380

Provider Business Practice Location Address
First Line	:	7421 S OUTER 364 STE B
Second Line	:
City	:	DARDENNE PRAIRIE
State	:	MO
Zip	:	63368-7014
Country	:	US
Telephone Number	:	636-561-2060
Fax Number	:	636-561-4380

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

Provider Enumeration Date	:	06/19/2017
Last Update Date	:	07/21/2022

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