Provider Demographics
NPI:1689005076
Name:NORMAN, ERICA (PTA)
Entity Type:Individual
Prefix:
First Name:ERICA
Middle Name:
Last Name:NORMAN
Suffix:
Gender:F
Credentials:PTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:101 JACKSON WALK PLZ
Mailing Address - Street 2:
Mailing Address - City:JACKSON
Mailing Address - State:TN
Mailing Address - Zip Code:38301-3008
Mailing Address - Country:US
Mailing Address - Phone:731-427-7048
Mailing Address - Fax:731-660-8739
Practice Address - Street 1:101 JACKSON WALK PLZ
Practice Address - Street 2:
Practice Address - City:JACKSON
Practice Address - State:TN
Practice Address - Zip Code:38301-3008
Practice Address - Country:US
Practice Address - Phone:731-427-7048
Practice Address - Fax:731-660-8739
Is Sole Proprietor?:No
Enumeration Date:2013-12-10
Last Update Date:2013-12-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN4594225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant