Provider Demographics
NPI:1801856448
Name:FREEMAN, ERICA R (P T)
Entity Type:Individual
Prefix:MRS
First Name:ERICA
Middle Name:R
Last Name:FREEMAN
Suffix:
Gender:F
Credentials:P T
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7691 TUSCANY WAY
Mailing Address - Street 2:
Mailing Address - City:FARMINGTON
Mailing Address - State:NM
Mailing Address - Zip Code:87402-1026
Mailing Address - Country:US
Mailing Address - Phone:505-419-1372
Mailing Address - Fax:
Practice Address - Street 1:583 COUNTY ROAD 6100
Practice Address - Street 2:
Practice Address - City:KIRTLAND
Practice Address - State:NM
Practice Address - Zip Code:87417-9318
Practice Address - Country:US
Practice Address - Phone:505-368-4984
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-03-27
Last Update Date:2009-01-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NM3337225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist