Provider Demographics
NPI:1114907318
Name:VOTRUBA, ERIKA (DPT)
Entity Type:Individual
Prefix:MS
First Name:ERIKA
Middle Name:
Last Name:VOTRUBA
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 1:1133 MONTAUK HWY
Mailing Address - Street 2:
Mailing Address - City:MASTIC
Mailing Address - State:NY
Mailing Address - Zip Code:11950-2918
Mailing Address - Country:US
Mailing Address - Phone:631-399-0007
Mailing Address - Fax:631-399-2992
Practice Address - Street 1:1636 MONTAUK HWY
Practice Address - Street 2:
Practice Address - City:MASTIC
Practice Address - State:NY
Practice Address - Zip Code:11950-3016
Practice Address - Country:US
Practice Address - Phone:631-399-0007
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-01-23
Last Update Date:2019-05-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
225100000X
NY027506-1225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY04206608Medicaid