Provider Demographics
NPI:1073037511
Name:FIREBAUGH, ERIKA DAWN (DPT)
Entity Type:Individual
Prefix:
First Name:ERIKA
Middle Name:DAWN
Last Name:FIREBAUGH
Suffix:
Gender:F
Credentials:DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6700 JEFFERSON ST NE BLDG E
Mailing Address - Street 2:
Mailing Address - City:ALBUQUERQUE
Mailing Address - State:NM
Mailing Address - Zip Code:87109-4393
Mailing Address - Country:US
Mailing Address - Phone:505-948-4555
Mailing Address - Fax:
Practice Address - Street 1:6700 JEFFERSON ST NE BLDG E
Practice Address - Street 2:
Practice Address - City:ALBUQUERQUE
Practice Address - State:NM
Practice Address - Zip Code:87109-4393
Practice Address - Country:US
Practice Address - Phone:505-948-4555
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-07-26
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NM5106225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist