Provider Demographics
NPI:1134504558
Name:DEVESA, ERIN DOREEN
Entity Type:Individual
Prefix:
First Name:ERIN
Middle Name:DOREEN
Last Name:DEVESA
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:ERIN
Other - Middle Name:DOREEN
Other - Last Name:DOYLE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:112 NC 54 APT V5
Mailing Address - Street 2:
Mailing Address - City:CARRBORO
Mailing Address - State:NC
Mailing Address - Zip Code:27510-1587
Mailing Address - Country:US
Mailing Address - Phone:352-284-3145
Mailing Address - Fax:
Practice Address - Street 1:112 NC 54 APT V5
Practice Address - Street 2:
Practice Address - City:CARRBORO
Practice Address - State:NC
Practice Address - Zip Code:27510-1587
Practice Address - Country:US
Practice Address - Phone:352-284-3145
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-07-27
Last Update Date:2015-07-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
COPTL.0013211225100000X
FLPT24769225100000X
NCP14784225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist