MEDICARE: CHARLES LWIN PTA

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	2251G0304X	Geriatric Physical Therapist	29519	FL

General Provider Information

NPI Number	:	1356172506
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	CHARLES LWIN PTA

Provider Business Mailing Address
First Line	:	2919 WYCOMBE WAY
Second Line	:
City	:	PALM HARBOR
State	:	FL
Zip	:	34685-1300
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	1176 N JASMINE AVE
Second Line	:
City	:	TARPON SPRINGS
State	:	FL
Zip	:	34689-5235
Country	:	US
Telephone Number	:	727-743-1953
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	08/09/2024
Last Update Date	:	08/09/2024

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Directions to “ CHARLES LWIN PTA” Practice Location

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