Provider Demographics
NPI:1073721445
Name:ERRICO, DEANNA M (PT, ATC)
Entity Type:Individual
Prefix:
First Name:DEANNA
Middle Name:M
Last Name:ERRICO
Suffix:
Gender:F
Credentials:PT, ATC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:21 WELLS ST
Mailing Address - Street 2:
Mailing Address - City:CANTON
Mailing Address - State:NY
Mailing Address - Zip Code:13617-1244
Mailing Address - Country:US
Mailing Address - Phone:315-268-3853
Mailing Address - Fax:315-268-1539
Practice Address - Street 1:80 E MAIN ST
Practice Address - Street 2:CANTON PHYSICAL THERAPY, EJ NOBLE BLDG
Practice Address - City:CANTON
Practice Address - State:NY
Practice Address - Zip Code:13617-1450
Practice Address - Country:US
Practice Address - Phone:315-261-5490
Practice Address - Fax:315-261-6490
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-18
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY024679225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist