Provider Demographics
NPI:1265678288
Name:ELWIN, CARLEEN CHRISTINE (PTA)
Entity Type:Individual
Prefix:MRS
First Name:CARLEEN
Middle Name:CHRISTINE
Last Name:ELWIN
Suffix:
Gender:F
Credentials:PTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:26 ASULUM ST.
Mailing Address - Street 2:
Mailing Address - City:MILFORD
Mailing Address - State:MA
Mailing Address - Zip Code:01757
Mailing Address - Country:US
Mailing Address - Phone:508-473-0400
Mailing Address - Fax:508-473-3440
Practice Address - Street 1:40 NORTH MAIN ST.
Practice Address - Street 2:
Practice Address - City:BELLINGHAM
Practice Address - State:MA
Practice Address - Zip Code:02019
Practice Address - Country:US
Practice Address - Phone:508-966-2717
Practice Address - Fax:508-966-2095
Is Sole Proprietor?:No
Enumeration Date:2008-12-22
Last Update Date:2019-05-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
RI#PTA00141225200000X
MA#142225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant