Provider Demographics
NPI:1871534180
Name:CARROLL, NEIL K (ATC)
Entity type:Individual
Prefix:
First Name:NEIL
Middle Name:K
Last Name:CARROLL
Suffix:
Gender:M
Credentials:ATC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:100 BRICKHILL AVE
Mailing Address - Street 2:SUITE 303
Mailing Address - City:SOUTH PORTLAND
Mailing Address - State:ME
Mailing Address - Zip Code:04106-1999
Mailing Address - Country:US
Mailing Address - Phone:207-773-0040
Mailing Address - Fax:207-774-6501
Practice Address - Street 1:100 BRICKHILL AVE
Practice Address - Street 2:SUITE 303
Practice Address - City:SOUTH PORTLAND
Practice Address - State:ME
Practice Address - Zip Code:04106-1999
Practice Address - Country:US
Practice Address - Phone:207-773-0040
Practice Address - Fax:207-774-6501
Is Sole Proprietor?:No
Enumeration Date:2006-06-09
Last Update Date:2014-07-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MEAT2442255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer