Provider Demographics
NPI:1376007443
Name:ALLEN, ERICA N (ATC)
Entity Type:Individual
Prefix:
First Name:ERICA
Middle Name:N
Last Name:ALLEN
Suffix:
Gender:F
Credentials:ATC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8040 CRIANZA PL APT 255
Mailing Address - Street 2:
Mailing Address - City:VIENNA
Mailing Address - State:VA
Mailing Address - Zip Code:22182-4062
Mailing Address - Country:US
Mailing Address - Phone:571-271-7784
Mailing Address - Fax:
Practice Address - Street 1:8040 CRIANZA PL APT 255
Practice Address - Street 2:
Practice Address - City:VIENNA
Practice Address - State:VA
Practice Address - Zip Code:22182-4062
Practice Address - Country:US
Practice Address - Phone:571-271-7784
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-01-23
Last Update Date:2020-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA01260034122255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer