Provider Demographics
NPI:1174959134
Name:ROY, CARRIE LYNN (PT)
Entity type:Individual
Prefix:
First Name:CARRIE
Middle Name:LYNN
Last Name:ROY
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:14 CONGER AVE
Mailing Address - Street 2:
Mailing Address - City:BURLINGTON
Mailing Address - State:VT
Mailing Address - Zip Code:05401-5234
Mailing Address - Country:US
Mailing Address - Phone:802-578-5439
Mailing Address - Fax:
Practice Address - Street 1:3 HOME HEALTH CIR
Practice Address - Street 2:
Practice Address - City:SAINT ALBANS
Practice Address - State:VT
Practice Address - Zip Code:05478-9737
Practice Address - Country:US
Practice Address - Phone:802-527-7531
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-09-23
Last Update Date:2013-09-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VT040.0094905225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist