Provider Demographics
NPI:1508310756
Name:BORETTI, ERICA (PT, DPT)
Entity Type:Individual
Prefix:
First Name:ERICA
Middle Name:
Last Name:BORETTI
Suffix:
Gender:F
Credentials:PT, DPT
Other - Prefix:
Other - First Name:ERICA
Other - Middle Name:
Other - Last Name:HICKS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PT, DPT
Mailing Address - Street 1:10 NEW DRIFTWAY STE 301
Mailing Address - Street 2:
Mailing Address - City:SCITUATE
Mailing Address - State:MA
Mailing Address - Zip Code:02066-4546
Mailing Address - Country:US
Mailing Address - Phone:781-378-2352
Mailing Address - Fax:781-378-1760
Practice Address - Street 1:10 NEW DRIFTWAY STE 301
Practice Address - Street 2:
Practice Address - City:SCITUATE
Practice Address - State:MA
Practice Address - Zip Code:02066-4546
Practice Address - Country:US
Practice Address - Phone:781-378-2352
Practice Address - Fax:781-378-1760
Is Sole Proprietor?:No
Enumeration Date:2016-08-04
Last Update Date:2022-02-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA22510225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist