Provider Demographics
NPI:1619760964
Name:CONTIN, CARLA ROSE ELLSWORTH
Entity type:Individual
Prefix:
First Name:CARLA
Middle Name:ROSE ELLSWORTH
Last Name:CONTIN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12040 S JOG RD STE 7
Mailing Address - Street 2:
Mailing Address - City:BOYNTON BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:33437-4164
Mailing Address - Country:US
Mailing Address - Phone:561-931-3011
Mailing Address - Fax:561-510-7152
Practice Address - Street 1:12040 S JOG RD STE 7
Practice Address - Street 2:
Practice Address - City:BOYNTON BEACH
Practice Address - State:FL
Practice Address - Zip Code:33437-4164
Practice Address - Country:US
Practice Address - Phone:561-931-3011
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-05-28
Last Update Date:2025-05-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist