Provider Demographics
NPI:1366451452
Name:DERENICK, ERIN E (PT, MSPT, DPT)
Entity Type:Individual
Prefix:
First Name:ERIN
Middle Name:E
Last Name:DERENICK
Suffix:
Gender:F
Credentials:PT, MSPT, DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1298 BOYD RD
Mailing Address - Street 2:
Mailing Address - City:STREET
Mailing Address - State:MD
Mailing Address - Zip Code:21154-1828
Mailing Address - Country:US
Mailing Address - Phone:516-606-4251
Mailing Address - Fax:
Practice Address - Street 1:744 S PHILADELPHIA BLVD STE C
Practice Address - Street 2:
Practice Address - City:ABERDEEN
Practice Address - State:MD
Practice Address - Zip Code:21001-3655
Practice Address - Country:US
Practice Address - Phone:410-339-1951
Practice Address - Fax:410-505-0229
Is Sole Proprietor?:No
Enumeration Date:2006-08-07
Last Update Date:2023-11-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD21989225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD468MS348Medicare Oscar/Certification