Provider Demographics
NPI:1851789499
Name:PULCE-PERRY, ERICA (PT)
Entity Type:Individual
Prefix:
First Name:ERICA
Middle Name:
Last Name:PULCE-PERRY
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:712 W 2ND ST
Mailing Address - Street 2:
Mailing Address - City:LEAVENWORTH
Mailing Address - State:IN
Mailing Address - Zip Code:47137
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:712 W 2ND ST
Practice Address - Street 2:
Practice Address - City:LEAVENWORTH
Practice Address - State:IN
Practice Address - Zip Code:47137-2264
Practice Address - Country:US
Practice Address - Phone:812-739-2292
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-01-06
Last Update Date:2015-01-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN05010283A225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist