Provider Demographics
NPI:1588859789
Name:KISH, ERICA LYNN (PT, MPT)
Entity Type:Individual
Prefix:MISS
First Name:ERICA
Middle Name:LYNN
Last Name:KISH
Suffix:
Gender:F
Credentials:PT, MPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 100
Mailing Address - Street 2:
Mailing Address - City:SAINT MICHAELS
Mailing Address - State:AZ
Mailing Address - Zip Code:86511-0100
Mailing Address - Country:US
Mailing Address - Phone:928-871-2822
Mailing Address - Fax:928-871-2837
Practice Address - Street 1:MUSTANG ROAD, 1 MILE NORTH OF RT 264
Practice Address - Street 2:
Practice Address - City:SAINT MICHAELS
Practice Address - State:AZ
Practice Address - Zip Code:86511-0100
Practice Address - Country:US
Practice Address - Phone:928-871-2822
Practice Address - Fax:928-871-2837
Is Sole Proprietor?:Yes
Enumeration Date:2007-09-11
Last Update Date:2007-09-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ7806225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist