Provider Demographics
NPI:1205486560
Name:DE LEON, CARRINA
Entity type:Individual
Prefix:
First Name:CARRINA
Middle Name:
Last Name:DE LEON
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:CARRINA
Other - Middle Name:
Other - Last Name:CHIN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:125 LEWIS WHARF
Mailing Address - Street 2:
Mailing Address - City:BOSTON
Mailing Address - State:MA
Mailing Address - Zip Code:02110-3926
Mailing Address - Country:US
Mailing Address - Phone:617-523-2766
Mailing Address - Fax:
Practice Address - Street 1:125 LEWIS WHARF
Practice Address - Street 2:
Practice Address - City:BOSTON
Practice Address - State:MA
Practice Address - Zip Code:02110-3926
Practice Address - Country:US
Practice Address - Phone:617-523-2766
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-09-18
Last Update Date:2020-03-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA24515225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist