Provider Demographics
NPI:1912567959
Name:GISH, ERIN (PT, DPT)
Entity Type:Individual
Prefix:DR
First Name:ERIN
Middle Name:
Last Name:GISH
Suffix:
Gender:F
Credentials:PT, DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3985 STEVE REYNOLDS BLVD BLDG G
Mailing Address - Street 2:
Mailing Address - City:NORCROSS
Mailing Address - State:GA
Mailing Address - Zip Code:30093-3001
Mailing Address - Country:US
Mailing Address - Phone:770-622-2532
Mailing Address - Fax:
Practice Address - Street 1:3985 STEVE REYNOLDS BLVD BLDG G
Practice Address - Street 2:
Practice Address - City:NORCROSS
Practice Address - State:GA
Practice Address - Zip Code:30093-3001
Practice Address - Country:US
Practice Address - Phone:770-622-2532
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-06-20
Last Update Date:2019-06-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GAPT0140582251P0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2251P0200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistPediatrics