Individual
LARISSA RAE CARROLL
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
ATC, LAT
Contact information
Practice address
901 HIGHLAND AVE, ORLANDO, FL 32803-3233
(407) 206-1900
Mailing address
1837 OSMAN AVE, ORLANDO, FL 32806
(941) 266-7041
Taxonomy
Speciality
Code
Description
License number
State
2255A2300X
Athletic Trainer
Primary
AL 4180
FL
Other
Enumeration date
09/01/2016
Last updated
09/01/2016
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