Provider Demographics
NPI:1578229886
Name:ATTERBERRY, ERICA MARIE (PTA, ATC, LAT)
Entity Type:Individual
Prefix:
First Name:ERICA
Middle Name:MARIE
Last Name:ATTERBERRY
Suffix:
Gender:F
Credentials:PTA, ATC, LAT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2518 HIDDEN VALLEY DR
Mailing Address - Street 2:
Mailing Address - City:HOLTS SUMMIT
Mailing Address - State:MO
Mailing Address - Zip Code:65043-2524
Mailing Address - Country:US
Mailing Address - Phone:314-974-2235
Mailing Address - Fax:
Practice Address - Street 1:1002 DIAMOND RDG STE 800
Practice Address - Street 2:
Practice Address - City:JEFFERSON CITY
Practice Address - State:MO
Practice Address - Zip Code:65109-7906
Practice Address - Country:US
Practice Address - Phone:573-761-9360
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-11-10
Last Update Date:2021-11-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO20130056802255A2300X
MO2016037444225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant
No2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer