Provider Demographics
NPI:1629554191
Name:NEASE, ERICA (PT)
Entity Type:Individual
Prefix:
First Name:ERICA
Middle Name:
Last Name:NEASE
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:WACHTER
Other - Middle Name:C
Other - Last Name:ERICA
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:PO BOX 1475
Mailing Address - Street 2:
Mailing Address - City:DES MOINES
Mailing Address - State:IA
Mailing Address - Zip Code:50305-1475
Mailing Address - Country:US
Mailing Address - Phone:515-222-7350
Mailing Address - Fax:515-222-7355
Practice Address - Street 1:1601 NW 114TH ST STE 155
Practice Address - Street 2:
Practice Address - City:CLIVE
Practice Address - State:IA
Practice Address - Zip Code:50325-7046
Practice Address - Country:US
Practice Address - Phone:515-222-7350
Practice Address - Fax:515-222-7355
Is Sole Proprietor?:No
Enumeration Date:2018-07-17
Last Update Date:2018-07-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA03769225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist