Provider Demographics
NPI:1154846178
Name:DONNELLY, ERICA (DPT)
Entity Type:Individual
Prefix:
First Name:ERICA
Middle Name:
Last Name:DONNELLY
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 1:250 E MAIN ST
Mailing Address - Street 2:
Mailing Address - City:NORTON
Mailing Address - State:MA
Mailing Address - Zip Code:02766-2436
Mailing Address - Country:US
Mailing Address - Phone:857-444-1005
Mailing Address - Fax:508-285-4483
Practice Address - Street 1:2 BELMONT STREET
Practice Address - Street 2:
Practice Address - City:NORTH EASTON
Practice Address - State:MA
Practice Address - Zip Code:02356
Practice Address - Country:US
Practice Address - Phone:857-444-1026
Practice Address - Fax:857-444-5026
Is Sole Proprietor?:No
Enumeration Date:2017-08-10
Last Update Date:2021-04-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA23213225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist