Provider Demographics
NPI:1750625869
Name:ERWIN, JOHN Q (LMT)
Entity type:Individual
Prefix:MR
First Name:JOHN
Middle Name:Q
Last Name:ERWIN
Suffix:
Gender:M
Credentials:LMT
Other - Prefix:
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Mailing Address - Street 1:49 WEST ST
Mailing Address - Street 2:
Mailing Address - City:BOLTON
Mailing Address - State:CT
Mailing Address - Zip Code:06043-7711
Mailing Address - Country:US
Mailing Address - Phone:860-604-2533
Mailing Address - Fax:860-647-8487
Practice Address - Street 1:80 SEYMOUR ST
Practice Address - Street 2:
Practice Address - City:HARTFORD
Practice Address - State:CT
Practice Address - Zip Code:06102-8000
Practice Address - Country:US
Practice Address - Phone:860-545-4444
Practice Address - Fax:860-545-4311
Is Sole Proprietor?:Yes
Enumeration Date:2012-11-15
Last Update Date:2012-11-15
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
CT004967225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist