Provider Demographics
NPI:1689882532
Name:STRATFORD, ERIN ELIZABETH (MPT)
Entity Type:Individual
Prefix:MRS
First Name:ERIN
Middle Name:ELIZABETH
Last Name:STRATFORD
Suffix:
Gender:F
Credentials:MPT
Other - Prefix:MISS
Other - First Name:ERIN
Other - Middle Name:ELIZABETH
Other - Last Name:BOSLEY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MPT
Mailing Address - Street 1:23 FITNESS LN
Mailing Address - Street 2:
Mailing Address - City:BERKELEY SPRINGS
Mailing Address - State:WV
Mailing Address - Zip Code:25411-7080
Mailing Address - Country:US
Mailing Address - Phone:304-258-1300
Mailing Address - Fax:304-258-1400
Practice Address - Street 1:23 FITNESS LANE
Practice Address - Street 2:
Practice Address - City:BERKELEY SPRINGS
Practice Address - State:WV
Practice Address - Zip Code:25411-7080
Practice Address - Country:US
Practice Address - Phone:304-258-1300
Practice Address - Fax:304-258-1400
Is Sole Proprietor?:No
Enumeration Date:2007-05-21
Last Update Date:2009-04-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WVPT 002437225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
WV205384100OtherUS DEPT OF LABOR
WV9173100OtherAETNA
WV001800554OtherBCBS
WV3810010878Medicaid
MD414365500Medicaid
WV1072723OtherBRICKSTREET
WV2726960OtherCIGNA
MD92711601OtherBCBS
WV001800554OtherBCBS
WV1072723OtherBRICKSTREET