Provider Demographics
NPI:1023312436
Name:LEASE, ERCA
Entity type:Individual
Prefix:
First Name:ERCA
Middle Name:
Last Name:LEASE
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1013 W MAIN ST.
Mailing Address - Street 2:SUIT 1
Mailing Address - City:MOUNT JOY
Mailing Address - State:PA
Mailing Address - Zip Code:17552
Mailing Address - Country:US
Mailing Address - Phone:717-367-6224
Mailing Address - Fax:717-823-6382
Practice Address - Street 1:1013 W MAIN ST.
Practice Address - Street 2:SUIT 1
Practice Address - City:MOUNT JOY
Practice Address - State:PA
Practice Address - Zip Code:17552
Practice Address - Country:US
Practice Address - Phone:717-367-6224
Practice Address - Fax:717-823-6382
Is Sole Proprietor?:No
Enumeration Date:2010-12-28
Last Update Date:2010-12-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist