MEDICARE: NATALIE CARROLL PTA

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	225200000X	Physical Therapy Assistant	PTA-014019	AZ

General Provider Information

NPI Number	:	1811654478
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	NATALIE CARROLL PTA

Provider Business Mailing Address
First Line	:	PO BOX 457
Second Line	:
City	:	SHOW LOW
State	:	AZ
Zip	:	85902-0457
Country	:	US
Telephone Number	:	928-537-2678
Fax Number	:

Provider Business Practice Location Address
First Line	:	1684 E WHITE MOUNTAIN BLVD STE B
Second Line	:
City	:	PINETOP
State	:	AZ
Zip	:	85935-5015
Country	:	US
Telephone Number	:	928-537-2678
Fax Number	:

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

Provider Enumeration Date	:	11/18/2021
Last Update Date	:	11/18/2021

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Directions to “ NATALIE CARROLL PTA” Practice Location

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