Basic Information
| Provider Information | |||||||||
| NPI: | 1518151711 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | CARROLL | ||||||||
| FirstName: | LINDA | ||||||||
| MiddleName: | LEE | ||||||||
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| Credential: | PTA | ||||||||
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| Mailing Information | |||||||||
| Address1: | 334 MAIN STREET | ||||||||
| Address2: | P.O. BOX 92 | ||||||||
| City: | WAMPUM | ||||||||
| State: | PA | ||||||||
| PostalCode: | 16157 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7246748646 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | 257 GEORGETOWN RD | ||||||||
| Address2: | |||||||||
| City: | BEAVER FALLS | ||||||||
| State: | PA | ||||||||
| PostalCode: | 150109740 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7248468200 | ||||||||
| FaxNumber: | 7248472998 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 08/30/2007 | ||||||||
| LastUpdateDate: | 11/15/2013 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 225200000X | TE007201 | PA | Y | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Physical Therapy Assistant |
No ID Information.