Provider Demographics
NPI:1326117326
Name:FLETCHER, ERICA MARIE (PT)
Entity Type:Individual
Prefix:
First Name:ERICA
Middle Name:MARIE
Last Name:FLETCHER
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:605 BEECHWOOD DR
Mailing Address - Street 2:
Mailing Address - City:HAVERTOWN
Mailing Address - State:PA
Mailing Address - Zip Code:19083-2613
Mailing Address - Country:US
Mailing Address - Phone:610-639-6586
Mailing Address - Fax:610-668-1461
Practice Address - Street 1:234 WOODBINE AVE
Practice Address - Street 2:2ND FLOOR
Practice Address - City:NARBERTH
Practice Address - State:PA
Practice Address - Zip Code:19072-1930
Practice Address - Country:US
Practice Address - Phone:610-639-6586
Practice Address - Fax:610-668-1461
Is Sole Proprietor?:No
Enumeration Date:2006-11-06
Last Update Date:2008-06-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAPT001330E225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA160503Medicare ID - Type Unspecified