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NPI Code Detail

MEDICARE: KACI ANN CARROLL DPT

MEDICARE: KACI ANN CARROLL 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 Therapist2520ND
2225100000XPhysical Therapist11821MN

General Provider Information

NPI Number : 1841897279
Entity Type Code : Individual
Provider Name (Legal Business Name) : KACI ANN CARROLL DPT
Provider Business Mailing Address
First Line : 688 WILDWOOD RD
Second Line :
City : MAHTOMEDI
State : MN
Zip : 55115-1812
Country : US
Telephone Number : 651-429-9947
Fax Number :
Provider Business Practice Location Address
First Line : 688 WILDWOOD RD
Second Line :
City : MAHTOMEDI
State : MN
Zip : 55115-1812
Country : US
Telephone Number : 651-429-9947
Fax Number : 651-429-1029
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 10/08/2020
Last Update Date : 06/26/2025

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Directions to “ KACI ANN CARROLL DPT” Practice Location

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