Provider Demographics
NPI:1043790488
Name:TRIPLETT, ERICA TOMESHA (LMT)
Entity Type:Individual
Prefix:
First Name:ERICA
Middle Name:TOMESHA
Last Name:TRIPLETT
Suffix:
Gender:F
Credentials:LMT
Other - Prefix:MRS
Other - First Name:ERICA
Other - Middle Name:TOMESHA
Other - Last Name:WATSON-HART
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:LMT
Mailing Address - Street 1:4020 HIGH ST
Mailing Address - Street 2:
Mailing Address - City:ECORSE
Mailing Address - State:MI
Mailing Address - Zip Code:48229-1648
Mailing Address - Country:US
Mailing Address - Phone:313-265-0656
Mailing Address - Fax:
Practice Address - Street 1:4020 HIGH ST
Practice Address - Street 2:
Practice Address - City:ECORSE
Practice Address - State:MI
Practice Address - Zip Code:48229-1648
Practice Address - Country:US
Practice Address - Phone:313-265-0656
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-08-15
Last Update Date:2018-08-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI7501010340225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist