Basic Information
| Provider Information | |||||||||
| NPI: | 1477064145 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | CARLIN | ||||||||
| FirstName: | ANDREW | ||||||||
| MiddleName: | THOMAS | ||||||||
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| Credential: | PT, DPT | ||||||||
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| Mailing Information | |||||||||
| Address1: | 2420 LAKE AVE | ||||||||
| Address2: | |||||||||
| City: | ASHTABULA | ||||||||
| State: | OH | ||||||||
| PostalCode: | 440044954 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4409972262 | ||||||||
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| Practice Location | |||||||||
| Address1: | 2515 LAKE AVE | ||||||||
| Address2: | |||||||||
| City: | ASHTABULA | ||||||||
| State: | OH | ||||||||
| PostalCode: | 440044955 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4409976680 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 10/20/2017 | ||||||||
| LastUpdateDate: | 10/20/2017 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 225100000X | 014921 | OH | Y | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Physical Therapist |
No ID Information.