Provider Demographics
NPI:1578831475
Name:GIRARD, ERIN LEE (PT)
Entity Type:Individual
Prefix:
First Name:ERIN
Middle Name:LEE
Last Name:GIRARD
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2 FALL MOUNTAIN RD
Mailing Address - Street 2:
Mailing Address - City:TERRYVILLE
Mailing Address - State:CT
Mailing Address - Zip Code:06786-6826
Mailing Address - Country:US
Mailing Address - Phone:203-788-3967
Mailing Address - Fax:
Practice Address - Street 1:30 BUXTON FARM RD STE 230
Practice Address - Street 2:
Practice Address - City:STAMFORD
Practice Address - State:CT
Practice Address - Zip Code:06905-1206
Practice Address - Country:US
Practice Address - Phone:203-212-4191
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-12-06
Last Update Date:2018-01-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT00008205225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist