Provider Demographics
NPI:1063539427
Name:CARROLL, CATHERINE EILEEN (MSPT)
Entity type:Individual
Prefix:
First Name:CATHERINE
Middle Name:EILEEN
Last Name:CARROLL
Suffix:
Gender:F
Credentials:MSPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1215 JORDANTOWN RD
Mailing Address - Street 2:
Mailing Address - City:THAXTON
Mailing Address - State:VA
Mailing Address - Zip Code:24174-3143
Mailing Address - Country:US
Mailing Address - Phone:540-890-6851
Mailing Address - Fax:
Practice Address - Street 1:650 N JEFFERSON ST
Practice Address - Street 2:
Practice Address - City:ROANOKE
Practice Address - State:VA
Practice Address - Zip Code:24016-1427
Practice Address - Country:US
Practice Address - Phone:540-343-3484
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-03-23
Last Update Date:2010-01-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA2305003654225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist