Individual
PHILLIP CARROLL
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
CO
Contact information
Practice address
1130 COFFEE RD, SUITE B, MODESTO, CA 95355-4228
(209) 549-1000
(209) 549-1016
Mailing address
693 HI TECH PKWY, OAKDALE, CA 95361-9113
(209) 845-8231
(209) 845-2883
Taxonomy
Speciality
Code
Description
License number
State
222Z00000X
Orthotist
Primary
CO002162
CA
Other
Enumeration date
12/11/2008
Last updated
12/11/2008
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