Provider Demographics
NPI:1659703171
Name:KOTKIEWICZ, ERICA (PT, DPT)
Entity Type:Individual
Prefix:MS
First Name:ERICA
Middle Name:
Last Name:KOTKIEWICZ
Suffix:
Gender:F
Credentials:PT, DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:780 CYNTHIA DR
Mailing Address - Street 2:
Mailing Address - City:EAST MEADOW
Mailing Address - State:NY
Mailing Address - Zip Code:11554-4920
Mailing Address - Country:US
Mailing Address - Phone:516-850-9031
Mailing Address - Fax:
Practice Address - Street 1:780 CYNTHIA DR
Practice Address - Street 2:
Practice Address - City:EAST MEADOW
Practice Address - State:NY
Practice Address - Zip Code:11554-4920
Practice Address - Country:US
Practice Address - Phone:516-850-9031
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-08-07
Last Update Date:2020-01-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA39723225100000X
NY030339-1225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist