Provider Demographics
NPI:1922136860
Name:ERTLE, PATRICIA MARIE (PTA)
Entity Type:Individual
Prefix:MRS
First Name:PATRICIA
Middle Name:MARIE
Last Name:ERTLE
Suffix:
Gender:F
Credentials:PTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:911 W BROWARD ST
Mailing Address - Street 2:
Mailing Address - City:LANTANA
Mailing Address - State:FL
Mailing Address - Zip Code:33462-3129
Mailing Address - Country:US
Mailing Address - Phone:561-441-7755
Mailing Address - Fax:
Practice Address - Street 1:5155 W ATLANTIC AVE
Practice Address - Street 2:SUITE C
Practice Address - City:DELRAY BEACH
Practice Address - State:FL
Practice Address - Zip Code:33484-8170
Practice Address - Country:US
Practice Address - Phone:561-637-7195
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-03-01
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL20814225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant