Provider Demographics
NPI:1710483904
Name:ST. PIERRE, ERIC (LMT)
Entity Type:Individual
Prefix:
First Name:ERIC
Middle Name:
Last Name:ST. PIERRE
Suffix:
Gender:M
Credentials:LMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6209 CHICAGO AVE
Mailing Address - Street 2:
Mailing Address - City:PENSACOLA
Mailing Address - State:FL
Mailing Address - Zip Code:32526-1311
Mailing Address - Country:US
Mailing Address - Phone:850-293-3578
Mailing Address - Fax:
Practice Address - Street 1:4305 SPANISH TRL # RR
Practice Address - Street 2:
Practice Address - City:PENSACOLA
Practice Address - State:FL
Practice Address - Zip Code:32504-4942
Practice Address - Country:US
Practice Address - Phone:850-293-3578
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-04-05
Last Update Date:2018-04-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL81411225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist