Provider Demographics
NPI:1366550642
Name:EDVIN, CAROL (PT)
Entity type:Individual
Prefix:
First Name:CAROL
Middle Name:
Last Name:EDVIN
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:128 TYLER CT
Mailing Address - Street 2:
Mailing Address - City:CANADENSIS
Mailing Address - State:PA
Mailing Address - Zip Code:18325-7803
Mailing Address - Country:US
Mailing Address - Phone:603-667-7384
Mailing Address - Fax:
Practice Address - Street 1:128 TYLER CT
Practice Address - Street 2:
Practice Address - City:CANADENSIS
Practice Address - State:PA
Practice Address - Zip Code:18325-7803
Practice Address - Country:US
Practice Address - Phone:603-667-7384
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-08-28
Last Update Date:2023-08-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAPT025626225100000X, 225100000X
NH2983225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
VT01AI68397OtherBLUE CROSS BLUE SHIELD
1173197OtherCIGNA HEALTHCARE
NH303935CBMedicaid
VTORE8056Medicaid
2281038OtherFIRST HEALTH
3713145OtherAETNA
4130028OtherMVP
610995100OtherDEPT OF LABOR
AA24796OtherHARVARD PILGRIM
2281038OtherCCN
NH08Y007904NH01OtherBCBS NH
NHPLRE8059Medicare ID - Type Unspecified