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NPI Code Detail

MEDICARE: EMMA L CARROLL PT, DPT

MEDICARE: EMMA L CARROLL PT, DPT
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
1225100000XPhysical TherapistPTL.0016295CO

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1PTL.0016295OTHERCOCOLORADO DEPARTMENT OF REGULATORY AGENCIES DIVISION OF PROFESSIONS AND OCCUPATIO

General Provider Information

NPI Number : 1417417049
Entity Type Code : Individual
Provider Name (Legal Business Name) : EMMA L CARROLL PT, DPT
Provider Business Mailing Address
First Line : 10162 FAIRGATE WAY
Second Line :
City : HIGHLANDS RANCH
State : CO
Zip : 80126-7854
Country : US
Telephone Number : 714-334-7137
Fax Number :
Provider Business Practice Location Address
First Line : 112 N RUBEY DR UNIT 135
Second Line :
City : GOLDEN
State : CO
Zip : 80403-3214
Country : US
Telephone Number : 303-279-7703
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 03/20/2019
Last Update Date : 03/20/2019

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Directions to “ EMMA L CARROLL PT, DPT” Practice Location

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