Provider Demographics
NPI:1275932691
Name:MEYER, ERIN LEE (DPT)
Entity Type:Individual
Prefix:
First Name:ERIN
Middle Name:LEE
Last Name:MEYER
Suffix:
Gender:F
Credentials:DPT
Other - Prefix:
Other - First Name:ERIN
Other - Middle Name:
Other - Last Name:NETT
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:790 REMINGTON BLVD
Mailing Address - Street 2:
Mailing Address - City:BOLINGBROOK
Mailing Address - State:IL
Mailing Address - Zip Code:60440-4909
Mailing Address - Country:US
Mailing Address - Phone:630-296-2222
Mailing Address - Fax:630-759-6106
Practice Address - Street 1:15312 W BELOIT RD
Practice Address - Street 2:
Practice Address - City:NEW BERLIN
Practice Address - State:WI
Practice Address - Zip Code:53151-7447
Practice Address - Country:US
Practice Address - Phone:262-641-5771
Practice Address - Fax:262-641-6317
Is Sole Proprietor?:No
Enumeration Date:2014-08-21
Last Update Date:2014-09-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI12783-24225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
WIK400161704Medicare PIN