Provider Demographics
NPI:1891198958
Name:ERETH, DARREL (LPTA)
Entity Type:Individual
Prefix:
First Name:DARREL
Middle Name:
Last Name:ERETH
Suffix:
Gender:M
Credentials:LPTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:21330 HILLSDALE AVE
Mailing Address - Street 2:
Mailing Address - City:FAIRVIEW PARK
Mailing Address - State:OH
Mailing Address - Zip Code:44126-2117
Mailing Address - Country:US
Mailing Address - Phone:720-255-8870
Mailing Address - Fax:
Practice Address - Street 1:6455 PEARL RD
Practice Address - Street 2:
Practice Address - City:PARMA HEIGHTS
Practice Address - State:OH
Practice Address - Zip Code:44130-2984
Practice Address - Country:US
Practice Address - Phone:440-888-5900
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-10-03
Last Update Date:2014-10-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHPTA 09650225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant