Provider Demographics
NPI:1225312085
Name:WIBLE, ERICA JEAN (DPT)
Entity Type:Individual
Prefix:MS
First Name:ERICA
Middle Name:JEAN
Last Name:WIBLE
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 1:321 MAIN ST
Mailing Address - Street 2:SUITE D
Mailing Address - City:WINOOSKI
Mailing Address - State:VT
Mailing Address - Zip Code:05401-1380
Mailing Address - Country:US
Mailing Address - Phone:802-864-3785
Mailing Address - Fax:802-864-0274
Practice Address - Street 1:321 MAIN ST
Practice Address - Street 2:SUITE D
Practice Address - City:WINOOSKI
Practice Address - State:VT
Practice Address - Zip Code:05401-1380
Practice Address - Country:US
Practice Address - Phone:802-864-3785
Practice Address - Fax:802-864-0274
Is Sole Proprietor?:Yes
Enumeration Date:2011-09-28
Last Update Date:2011-09-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VT040.0076991225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist