Provider Demographics
NPI:1467955153
Name:CLONTS, ERICA DAWN (PTA)
Entity Type:Individual
Prefix:
First Name:ERICA
Middle Name:DAWN
Last Name:CLONTS
Suffix:
Gender:F
Credentials:PTA
Other - Prefix:
Other - First Name:ERICA
Other - Middle Name:DAWN
Other - Last Name:GONZALES
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:2855 INTERNATIONAL CIR
Mailing Address - Street 2:
Mailing Address - City:COLORADO SPRINGS
Mailing Address - State:CO
Mailing Address - Zip Code:80910-3144
Mailing Address - Country:US
Mailing Address - Phone:719-447-8822
Mailing Address - Fax:
Practice Address - Street 1:2855 INTERNATIONAL CIR
Practice Address - Street 2:
Practice Address - City:COLORADO SPRINGS
Practice Address - State:CO
Practice Address - Zip Code:80910-3144
Practice Address - Country:US
Practice Address - Phone:719-447-8822
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-03-09
Last Update Date:2018-03-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
COPTA.0014114225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant