Provider Demographics
NPI:1609575497
Name:ERWIN, EILEEN (LMT)
Entity Type:Individual
Prefix:
First Name:EILEEN
Middle Name:
Last Name:ERWIN
Suffix:
Gender:F
Credentials:LMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:22153 LONG BOW DR
Mailing Address - Street 2:
Mailing Address - City:CALIFORNIA
Mailing Address - State:MD
Mailing Address - Zip Code:20619-2244
Mailing Address - Country:US
Mailing Address - Phone:865-335-1562
Mailing Address - Fax:
Practice Address - Street 1:22780 THREE NOTCH RD
Practice Address - Street 2:
Practice Address - City:LEXINGTON PARK
Practice Address - State:MD
Practice Address - Zip Code:20653-1538
Practice Address - Country:US
Practice Address - Phone:301-737-0662
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-03-01
Last Update Date:2023-03-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDM05950225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist