Provider Demographics
NPI:1588616684
Name:WEST, ERICA (PT)
Entity Type:Individual
Prefix:
First Name:ERICA
Middle Name:
Last Name:WEST
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 1:88 STEWART WAY
Mailing Address - Street 2:
Mailing Address - City:WAKEFIELD
Mailing Address - State:RI
Mailing Address - Zip Code:02879-2752
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:140 POINT JUDITH RD
Practice Address - Street 2:SUITE 47
Practice Address - City:NARRAGANSETT
Practice Address - State:RI
Practice Address - Zip Code:02882-3477
Practice Address - Country:US
Practice Address - Phone:401-789-2077
Practice Address - Fax:401-782-4762
Is Sole Proprietor?:No
Enumeration Date:2006-05-17
Last Update Date:2013-05-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
RIRI00733225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist