Provider Demographics
NPI:1326695750
Name:ERICH, SHARLA DEE (LPT)
Entity Type:Individual
Prefix:
First Name:SHARLA
Middle Name:DEE
Last Name:ERICH
Suffix:
Gender:F
Credentials:LPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:136 BRIDGEVIEW PL
Mailing Address - Street 2:
Mailing Address - City:PORT LUDLOW
Mailing Address - State:WA
Mailing Address - Zip Code:98365-9214
Mailing Address - Country:US
Mailing Address - Phone:707-684-9701
Mailing Address - Fax:
Practice Address - Street 1:136 BRIDGEVIEW LN
Practice Address - Street 2:
Practice Address - City:PORT LUDLOW
Practice Address - State:WA
Practice Address - Zip Code:98365-9214
Practice Address - Country:US
Practice Address - Phone:707-684-9701
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-08-21
Last Update Date:2020-01-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA60796252225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist