Provider Demographics
NPI:1114409380
Name:DIANDRETH-SMITH, ERICA NICOLE (DPT)
Entity Type:Individual
Prefix:MRS
First Name:ERICA
Middle Name:NICOLE
Last Name:DIANDRETH-SMITH
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 1:4536 STATE ROUTE 136 STE 12
Mailing Address - Street 2:
Mailing Address - City:GREENSBURG
Mailing Address - State:PA
Mailing Address - Zip Code:15601-7918
Mailing Address - Country:US
Mailing Address - Phone:724-830-8815
Mailing Address - Fax:724-830-8813
Practice Address - Street 1:4536 STATE ROUTE 136 STE 12
Practice Address - Street 2:
Practice Address - City:GREENSBURG
Practice Address - State:PA
Practice Address - Zip Code:15601-7918
Practice Address - Country:US
Practice Address - Phone:724-830-8815
Practice Address - Fax:724-830-8813
Is Sole Proprietor?:No
Enumeration Date:2018-09-04
Last Update Date:2018-09-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAPT024864225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist