Active NPI
Bret D Carroll, P.T.
- Physical Therapist
- Owen, WI
National Provider Identifier
1609080258
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Physical Therapist
- License
- 4312-024
- Practice address
- W4266 State Highway 29
Owen, WI 54460-8932 - Phone
- (715) 229-2172
- Fax
- (715) 229-9482
- NPI assigned
- May 10, 2007
- Last updated
- Jul 9, 2007
- Sex
- Male
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Physical Therapist | 225100000X | 4312-024 | WI | Primary |
Addresses
Primary practice location
W4266 State Highway 29
Owen, WI 54460-8932
Mailing address
115 W Butternut St
Abbotsford, WI 54405-9546
Phone (715) 223-2959
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 4312-024 | WI | MD | Physical Therapist |
| 4312 | WI | MD | Physician Assistant |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Sport & Spine Clinic L.P. | Physical Therapist | Past | Accepting new patients |
| Stratford Therapy Services, Inc. | Physical Therapist | Past | Accepting new patients |
Organizations & group practices 2
Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.
-
- Physical Therapist
- Stratford, WI
- NPI 1780020396
-
- Physical Therapist
- Stratford, WI
- NPI 1992875942
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"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": [],
"endpoints": [],
"other_names": []
}Other providers in Owen, WI
Sources for this page
- 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.