Provider Demographics
NPI:1124019633
Name:EWIG, ERIC DAVID (PT)
Entity Type:Individual
Prefix:MR
First Name:ERIC
Middle Name:DAVID
Last Name:EWIG
Suffix:
Gender:M
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:935 TRANCAS ST
Mailing Address - Street 2:STE 4C
Mailing Address - City:NAPA
Mailing Address - State:CA
Mailing Address - Zip Code:94558-2932
Mailing Address - Country:US
Mailing Address - Phone:707-255-1212
Mailing Address - Fax:707-226-7409
Practice Address - Street 1:935 TRANCAS ST
Practice Address - Street 2:STE 4C
Practice Address - City:NAPA
Practice Address - State:CA
Practice Address - Zip Code:94558-2932
Practice Address - Country:US
Practice Address - Phone:707-255-1212
Practice Address - Fax:707-226-7409
Is Sole Proprietor?:Yes
Enumeration Date:2005-11-03
Last Update Date:2012-11-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPT23688225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAOPT236880Medicare ID - Type Unspecified