Bret D Carroll, P.T.

Primary specialty

Physical TherapistTaxonomy code 225100000X

License

4312-024 Issued in WI

Practice address

W4266 State Highway 29
Owen, WI 54460-8932

Phone

(715) 229-2172

Fax

(715) 229-9482

NPI assigned

May 10, 2007

Sex

Male

Sole proprietor

No

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

• Sport & Spine Clinic L.P.

  • Physical Therapist
  • Stratford, WI
  • NPI 1780020396
  NPD (past)
• Stratford Therapy Services, Inc.

  • Physical Therapist
  • Stratford, WI
  • NPI 1992875942
  NPD (past)

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Enrolled

State licenses

Practice roles

The complete NPPES record for this NPI in the NPI Registry API format, last updated by the provider on Jul 9, 2007.

{
    "created_epoch": "1178755200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1183939200000",
    "number": "1609080258",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "115 W BUTTERNUT ST",
            "city": "ABBOTSFORD",
            "state": "WI",
            "postal_code": "544059546",
            "telephone_number": "715-223-2959",
            "fax_number": "715-229-9482"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "W4266 STATE HIGHWAY 29",
            "city": "OWEN",
            "state": "WI",
            "postal_code": "544608932",
            "telephone_number": "715-229-2172",
            "fax_number": "715-229-9482"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "CARROLL",
        "first_name": "BRET",
        "middle_name": "D",
        "credential": "P.T.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2007-05-10",
        "last_updated": "2007-07-09",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "225100000X",
            "taxonomy_group": "",
            "desc": "Physical Therapist",
            "state": "WI",
            "license": "4312-024",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "40199400",
            "state": "WI"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Affinity & Beyond Homecare LLC
• Aspirus Stanley Hospital & Clinics, Inc.
• Alexandra Bochte, LPC
• Adam Joshua Carr, DC
• Clark County
• Clark County Health Care Center
• Kimberly Diamond
• Dr Tom Gelhaus
• Andrew Finnegan

• All providers in Owen, WI
• Physical Therapist in Wisconsin

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 9, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.