Provider Demographics
NPI:1821064577
Name:ERWAY, CARL J (PT)
Entity Type:Individual
Prefix:
First Name:CARL
Middle Name:J
Last Name:ERWAY
Suffix:
Gender:M
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2237 CROCKER RD
Mailing Address - Street 2:SUITE 110
Mailing Address - City:WESTLAKE
Mailing Address - State:OH
Mailing Address - Zip Code:44145-7605
Mailing Address - Country:US
Mailing Address - Phone:440-617-9600
Mailing Address - Fax:440-617-9608
Practice Address - Street 1:2237 CROCKER RD
Practice Address - Street 2:SUITE 110
Practice Address - City:WESTLAKE
Practice Address - State:OH
Practice Address - Zip Code:44145-7605
Practice Address - Country:US
Practice Address - Phone:440-617-9600
Practice Address - Fax:440-617-9608
Is Sole Proprietor?:No
Enumeration Date:2006-02-23
Last Update Date:2011-01-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHPT008770225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
000000335310OtherANTHEM
0402420OtherUNITED HEALTHCARE
OH2462722Medicaid
0634111OtherAETNA
0402420OtherUNITED HEALTHCARE
OH4043145Medicare PIN