Individual
AMY CARROLL
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PTA
Contact information
Practice address
N2950 STATE ROAD 67, LAKE GENEVA, WI 53147-2655
(262) 245-0535
Mailing address
4401 N MAIN ST, ROCKFORD, IL 61103-1277
(815) 877-8061
Taxonomy
Speciality
Code
Description
License number
State
225200000X
Physical Therapy Assistant
Primary
160005984
IL
225200000X
Physical Therapy Assistant
1820-19
WI
Other
Enumeration date
08/24/2011
Last updated
08/29/2012
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