Provider Demographics
NPI:1275650772
Name:CARLSON, ROBIN LYNN (PT)
Entity Type:Individual
Prefix:
First Name:ROBIN
Middle Name:LYNN
Last Name:CARLSON
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 1:3605 EUCLID AVE
Mailing Address - Street 2:
Mailing Address - City:BERWYN
Mailing Address - State:IL
Mailing Address - Zip Code:60402-3864
Mailing Address - Country:US
Mailing Address - Phone:708-484-0347
Mailing Address - Fax:708-401-0446
Practice Address - Street 1:3605 EUCLID AVE
Practice Address - Street 2:
Practice Address - City:BERWYN
Practice Address - State:IL
Practice Address - Zip Code:60402-3864
Practice Address - Country:US
Practice Address - Phone:708-484-0347
Practice Address - Fax:708-401-0446
Is Sole Proprietor?:No
Enumeration Date:2007-03-22
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL01626047OtherBC BS PROVIDER#
IL01626047OtherBC BS PROVIDER#