Provider Demographics
NPI:1386762466
Name:CARROLL, TERANCE DEAN (PT)
Entity type:Individual
Prefix:MR
First Name:TERANCE
Middle Name:DEAN
Last Name:CARROLL
Suffix:
Gender:M
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:9465 SEDGEWOOD DR
Mailing Address - Street 2:
Mailing Address - City:LAKE WORTH
Mailing Address - State:FL
Mailing Address - Zip Code:33467-6993
Mailing Address - Country:US
Mailing Address - Phone:561-255-7444
Mailing Address - Fax:561-966-5887
Practice Address - Street 1:4777 N CONGRESS AVE
Practice Address - Street 2:
Practice Address - City:BOYNTON BEACH
Practice Address - State:FL
Practice Address - Zip Code:33426-7941
Practice Address - Country:US
Practice Address - Phone:561-255-7444
Practice Address - Fax:561-966-5887
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-27
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPT19437225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLY0047Medicare UPIN