Provider Demographics
NPI:1164972956
Name:LLEWELLYN, CARLA ANN
Entity Type:Individual
Prefix:
First Name:CARLA
Middle Name:ANN
Last Name:LLEWELLYN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7505 GREENWAY CENTER DR
Mailing Address - Street 2:SUITE 301
Mailing Address - City:GREENBELT
Mailing Address - State:MD
Mailing Address - Zip Code:20770-3507
Mailing Address - Country:US
Mailing Address - Phone:301-474-6505
Mailing Address - Fax:301-474-2206
Practice Address - Street 1:7505 GREENWAY CENTER DR
Practice Address - Street 2:SUITE 301
Practice Address - City:GREENBELT
Practice Address - State:MD
Practice Address - Zip Code:20770-3507
Practice Address - Country:US
Practice Address - Phone:301-474-6505
Practice Address - Fax:301-474-2206
Is Sole Proprietor?:No
Enumeration Date:2016-10-05
Last Update Date:2016-10-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDA4526225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant