Active NPI
Robin Lynn Carlson, P.T.
- Physical Therapist
- Berwyn, IL
National Provider Identifier
1275650772
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Physical Therapist
- Practice address
- 3605 Euclid Ave
Berwyn, IL 60402-3864 - Phone
- (708) 484-0347
- Fax
- (708) 401-0446
- NPI assigned
- Mar 22, 2007
- Sex
- Female
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Physical Therapist | 225100000X | IL | Primary |
Addresses
Primary practice location
3605 Euclid Ave
Berwyn, IL 60402-3864
Mailing address
3605 Euclid Ave
Berwyn, IL 60402-3864
Phone (708) 484-0347
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 01626047 | Other | IL | BC BS PROVIDER# |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 070-005335 | IL | MD | Physical Therapist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1174521600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1183852800000",
"number": "1275650772",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "3605 EUCLID AVE",
"city": "BERWYN",
"state": "IL",
"postal_code": "604023864",
"telephone_number": "708-484-0347",
"fax_number": "708-401-0446"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "3605 EUCLID AVE",
"city": "BERWYN",
"state": "IL",
"postal_code": "604023864",
"telephone_number": "708-484-0347",
"fax_number": "708-401-0446"
}
],
"practiceLocations": [],
"basic": {
"last_name": "CARLSON",
"first_name": "ROBIN",
"middle_name": "LYNN",
"credential": "P.T.",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2007-03-22",
"last_updated": "2007-07-08",
"status": "A"
},
"taxonomies": [
{
"code": "225100000X",
"taxonomy_group": "",
"desc": "Physical Therapist",
"state": "IL",
"license": null,
"primary": true
}
],
"identifiers": [
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "BC BS PROVIDER#",
"identifier": "01626047",
"state": "IL"
}
],
"endpoints": [],
"other_names": []
}Other providers in Berwyn, IL
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 8, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.