Provider Demographics
NPI:1477892586
Name:SURRETT, ERIN ENSELEIT (DPT)
Entity Type:Individual
Prefix:
First Name:ERIN
Middle Name:ENSELEIT
Last Name:SURRETT
Suffix:
Gender:F
Credentials:DPT
Other - Prefix:
Other - First Name:ERIN
Other - Middle Name:RACHEL
Other - Last Name:ENSELEIT
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:600 PENNSYLVANIA AVE SE
Mailing Address - Street 2:SE STE 202
Mailing Address - City:WASHINGTON
Mailing Address - State:DC
Mailing Address - Zip Code:20003-4316
Mailing Address - Country:US
Mailing Address - Phone:800-793-5464
Mailing Address - Fax:267-321-2099
Practice Address - Street 1:600 PENNSYLVANIA AVE SE
Practice Address - Street 2:SE STE 202
Practice Address - City:WASHINGTON
Practice Address - State:DC
Practice Address - Zip Code:20003-4316
Practice Address - Country:US
Practice Address - Phone:800-793-5464
Practice Address - Fax:267-321-2099
Is Sole Proprietor?:Yes
Enumeration Date:2013-02-08
Last Update Date:2013-04-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DC871448225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
DCG02816Medicare PIN
DC272550YT9Medicare PIN