Provider Demographics
NPI:1790890606
Name:MCDERMOTT, ERIN STOCKTON (PT,CSCS)
Entity Type:Individual
Prefix:
First Name:ERIN
Middle Name:STOCKTON
Last Name:MCDERMOTT
Suffix:
Gender:F
Credentials:PT,CSCS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:16550 VENTURA BLVD
Mailing Address - Street 2:SUITE 400
Mailing Address - City:ENCINO
Mailing Address - State:CA
Mailing Address - Zip Code:91436-2004
Mailing Address - Country:US
Mailing Address - Phone:818-905-1331
Mailing Address - Fax:818-905-8836
Practice Address - Street 1:16550 VENTURA BLVD
Practice Address - Street 2:SUITE 400
Practice Address - City:ENCINO
Practice Address - State:CA
Practice Address - Zip Code:91436-2004
Practice Address - Country:US
Practice Address - Phone:818-905-1331
Practice Address - Fax:818-905-8836
Is Sole Proprietor?:No
Enumeration Date:2006-08-20
Last Update Date:2007-09-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPT32058208100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & Rehabilitation
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAWPT132058BMedicare ID - Type Unspecified