Provider Demographics
NPI:1871053397
Name:CARRELL, ANDREW (PT, DPT, CSCS)
Entity type:Individual
Prefix:
First Name:ANDREW
Middle Name:
Last Name:CARRELL
Suffix:
Gender:M
Credentials:PT, DPT, CSCS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:336 BROAD ST STE 203
Mailing Address - Street 2:
Mailing Address - City:ROME
Mailing Address - State:GA
Mailing Address - Zip Code:30161-3006
Mailing Address - Country:US
Mailing Address - Phone:386-851-0901
Mailing Address - Fax:386-851-2426
Practice Address - Street 1:1565 SAXON BLVD STE 301
Practice Address - Street 2:
Practice Address - City:DELTONA
Practice Address - State:FL
Practice Address - Zip Code:32725-5836
Practice Address - Country:US
Practice Address - Phone:386-851-0901
Practice Address - Fax:386-851-2426
Is Sole Proprietor?:No
Enumeration Date:2019-03-21
Last Update Date:2020-03-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPT35622225100000X
NMPT5431208100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
No208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & Rehabilitation