Provider Demographics
NPI:1699199711
Name:MUNN, ERIN M (PTA)
Entity Type:Individual
Prefix:
First Name:ERIN
Middle Name:M
Last Name:MUNN
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 1:7109 BACHMAN RD
Mailing Address - Street 2:
Mailing Address - City:SARDINIA
Mailing Address - State:OH
Mailing Address - Zip Code:45171-8242
Mailing Address - Country:US
Mailing Address - Phone:937-446-3500
Mailing Address - Fax:937-446-3559
Practice Address - Street 1:7109 BACHMAN RD
Practice Address - Street 2:
Practice Address - City:SARDINIA
Practice Address - State:OH
Practice Address - Zip Code:45171-8242
Practice Address - Country:US
Practice Address - Phone:937-446-3500
Practice Address - Fax:937-446-3559
Is Sole Proprietor?:No
Enumeration Date:2014-02-10
Last Update Date:2014-02-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHPTA.04654225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant