Provider Demographics
NPI:1336472901
Name:WHIGHT, ERIN M (DPT)
Entity Type:Individual
Prefix:MS
First Name:ERIN
Middle Name:M
Last Name:WHIGHT
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 1:210 37TH AVE E
Mailing Address - Street 2:#303
Mailing Address - City:SUPERIOR
Mailing Address - State:WI
Mailing Address - Zip Code:54880-4183
Mailing Address - Country:US
Mailing Address - Phone:715-817-7518
Mailing Address - Fax:715-395-5310
Practice Address - Street 1:3500 TOWER AVE
Practice Address - Street 2:
Practice Address - City:SUPERIOR
Practice Address - State:WI
Practice Address - Zip Code:54880-5335
Practice Address - Country:US
Practice Address - Phone:715-817-7518
Practice Address - Fax:715-395-5310
Is Sole Proprietor?:No
Enumeration Date:2009-09-14
Last Update Date:2014-04-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI11626-24225100000X
MN2829225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI11625-24OtherWISCONSIN PT LICENSE
MN2829OtherPT LICENSE